2015 Ninja PRITE Questions 2

Mirtazapine is an antagonist at which receptor?

ALPHAE2EADRENERGIC

Antidepressant causes Parkinson's sx:

AMOXAPINE

Pt taking venlafaxine for months stops abruptly and calls psychiatrist 3 days later with nausea, insomnia, muscle aches, anxiety, dizziness, and transient "electric shock" sensations. The most likely cause:

ANTIDEPRESSANT WITHDRAWAL

What medication strategies is most effective and rapid in the treatment of severe bipolar illness, manic phase?

ANTIPSYCHOTIC MEDICATION + LITHIUM OR VALPROATE

25 y/o pt receives haldol and develops laryngospasm: Tx? (2x)

BENZTROPINE

38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks, mood is improved, but has difficulty passing urine and mild erectile dysfunction. Appropriate action? (2x)

BETHANECHOL 25MG TID

Which of the following is a negative predictor response to treatment with ET in pts with MDD?

BORDERLINE PERSONALITY DISORDER

Lancinating face pain, triggered by minor sensory stimuli, best treated initially with:

CARBAMAZEPINE

Which drug used in the treatment of patients with epilepsy is assoc w hyponatremia?

CARBAMAZEPINE

Which of the following meds is associated with benign maculopapular rash in approximately 10E15% of pt's within the first 3 weeks of treatment?

CARBAMAZEPINE

Pt taking carbamazepine for BMD presents with weakness and pallor. The psychiatrist notes the presence of a nonEblanching rash on the patient's arms. The most immediate lab test to order is:

CBC

58 y/o pt is started on citalopram 20mg for MDD. After 3 wks pt reports some improvement in vegetative sxs but remains dysphoric. What is the next step?

CONTINUE CITALOPRAM AT THE PRESENT DOSE WITH NO ADDITIONAL MED

Pt w/ treatmentcresistant mania and h/o rapid cycling is being treated w/ carbamazepine and thyroxine. After adding clozapine the pt is clinically stabilized. The pt's most recent WBC is below 3,000. Intervention? (2x)

D/C CARBAMAZEPINE

MAOIs affect catecholamines by directly retarding:

DEACTIVATION

A psychiatrist wished to start an inpatient on a TCA but the pt is reluctant due to hearing these drugs may cause dry mouth, constipation, blurred vision and urinary retention. What TCA would have the least side effects?

DESIPRAMINE

Antidepressant preferred for >65 y/o for which blood levels are clinically useful (3x)

DESIPRAMINE

Which side effect occurs less frequently in pts treated with mirtazapine vs SSRIs?

DIARRHEA

Pt with treatment resistant, rapid cycling bipolar disorder who recently started lamotrigine develops a rash on the face. Pt admits to a mild sore throat and thinks he may have a fever. Which of the following is the best recommendation for the psychiatrist to make to the pt? (2x)

DISCONTINUE LAMOTRIGINE AND COME TO THE APPROPRIATE ER

Hair loss + weight gain are SE of which anticonvulsant

DIVALPROEX SODIUM

Side effect more frequent in carbamazepine than lithium

DIZZINESS

The risk of increased psychosis for pts with psychotic disorders who take bupropion is attributable to enhancement of:

DOPAMINE

45 y/o pt w/ first episode MDD, on Paxil and insightEoriented therapy, but depression worsens over months. Takes Paxil only occasionally, as he is worried about becoming dependent on it (a friend was addicted to Valium). Best intervention?

EDUCATE PATIENT ON THE DIFFERENCES BETWEEN ANTIDEPRESSANTS, LIKE PAXIL, AND BENZODIAZEPINES, LIKE VALIUM.

Which antibiotic may significantly raise carbamazepine levels and precipitate heart block?

ERYTHROMYCIN

Fatal reactions have occurred when monoamine oxidase inhibitors (MAOIs) are combined with which of the following medications?

FENTANYL

W pts over 65 w MDD, Bupropion has what advantage over SSRIs?

FEWER DRUG INTERACTIONS

What antidepressant has plasma level that correlates with therapeutic response? (2x)

IMIPRAMINE

After psychiatrist adds new med, pt turns bright red w/ sunburn like rash, similar to SJS. Which med caused this?

LAMOTRIGINE

What is the best reason for preferring the use of SSRI antidepressants over TCAs in tx of pts w/depression who are > 65yo?

LESS LIKELY TO CAUSE ORTHOSTATIC HYPOTENSION

8 y/o Dx w/ Bipolar d/o is about to start valproic acid. What needs to be monitored frequently?

LIVER FUNCTION

Which of the following baseline labs should be obtained for pt being treated with valproate?

LIVER FUNCTION TESTS

At 10 mg selegiline does not require dietary restriction b/c

MAOEB IS NOT INVOLVED WITH INTESTINAL TYRAMINE REACTION

Which of the following opioids has a potentially lethal interaction with monoamine oxidase inhibitors (MAOIs)? (4x)

MEPERIDINE

Pt taking phenelzine is treated in ED for chest pain. While treated, pt develops hyperreflexia, HTN, goes into coma. Which med is most likely cause?

MEPERIDINE (DEMEROL)

Which of the following agents has been shown to moderate weight gain in some pts treated w/ valproate and atypical antipsychotic?

METFORMIN

Which antidepressant has strongest histamineER affinity?

MIRTAZAPINE

MAOI least likely to cause drugEfood interaction in therapeutic antidepressant doses

MOCLOBEMIDE

Receptor blocked by antidepressants E> blurred vision

MUSCARINIC

Which antidepressant med is best to minimize risk of orthostasis in an 84 y/o? (4x)

NORTRIPTYLINE

Which med decreases the efficacy of oral contraceptive? (2x)

OXCARBAZEPINE

2 wks washout of which med is needed before starting fluoxetine

PHENELZINE

30 y/o pt has been treated for unreasonable fear of eating in public places, feeling of embarrassment in public places, and anger over the possibility of being scrutinized. Pt has not responded to high doses of paroxetine, citalopram, buspirone, and alprazolam, each of them administered for 4c6 wks. Which meds would be appropriate for next? (2x)

PHENELZINE

Treatment for patients with MAOI related hypertensive crisis in the ER may involve the administration of which of the following meds? (2x)

PHENTOLAMINE

25 yo CF started on desipramine 50mg Qday. SE of constipation, dry mouth, visual difficulties, tremor and agitated feeling. Not on any other medications. Blood level is 400ng/ml. Most likely cause?

POOR METABOLISM OF CYTOCHROME P450 SUBSTRATES

45 y/o F pt on phenelzine for MDD, takes OTC medication for cold sx and develops hypertensive crisis. Which OTC medication would most likely cause this? (3x)

PSEUDOEPHEDRINE

40 y/o pt experienced delirium, tremor, diaphoresis, rigidity, hyperpyrexia, and myoclonus in making the transition from the use of clomipramine to phenelzine. Pt is most likely experiencing:

SEROTONIN SYNDROME

50 y/o fireman became clinically depressed after sustaining a myocardial infarction. What is an appropriate medication to prescribe?

SERTRALINE

Which SSRI is recommended for postpartum mothers breastfeeding?

SERTRALINE

Which antidepressant has active metabolites that extend its effective halfElife?

SERTRALINE

Orthostatic hypotension is least likely to occur as a S/E with what antidepressants?

SERTRALINE. NORTRIPTYLINE, IMIPRAMINE, AMITRIPTYLINE, TRAZODONE ◊ ORTHOSTATIC HYPOTENSION

Mirtazepine (vs other antidepressants) has low incidence of what side effect?

SEXUAL SIDE EFFECTS

Key element in emergency treatment of pt w serotonin syndrome, beyond stopping offending agent is:

SUPPORTING VITAL FUNCTIONS

Most effective med most effective for migraine prophylaxis

TOPIRAMATE

Which of the following anticonvulsants may be associated with kidney stones? (2x)

TOPIRAMATE

70yo w depression plus confusion x 2wk following the start of fluoxetine . An adverse effect is suspected but neuro exam normal. What evaluation would be most useful to confirm suspicion of an adverse effect?

UREA AND ELECTROLYTES

Which is a muscarinic SE of antidepressants? (2x)

URINARY RETENTION

62 y/o pt with hx chest pain has and depression, one month ago started on paroxetine, presents with new onset of lethargy and headache, low Na and BUN, normal K , and Cr of 0.4. Next test: (2x)

URINE OSMOLALITY

4 y/o does not run/climb, falls, has iliopsoas/quadriceps/gluteal weakness, enlargement of calves with firm, "rubbery" consistency, decreased DTRs and normal sensation. Wide based stance and walks waddling. When rising from the ground, uses a fourEpoint position through full extension of all four extremities. Has family h/o similar sx in males. 1) EMG reveals? 2) Genetic mutation in what protein?

"1) SMALL, SHORTELASTING MOTOR UNIT POTENTIALS WITH INCREASED RECRUITMENT 2) DYSTROPHIN "

A new pt asks therapist, "are you Christian?" What is best response?

"ARE YOU CONCERNED THAT IF WE ARE NOT OF THE SAME RELIGION, I WON'T BE ABLE TO TREAT YOU PROPERLY?'

A new psychotherapy patient arrives for a first appointment, accompanied by the spouse. The pt asks if the spouse can be present during the interview. Which of the following is the most appropriate immediate response by the psychiatrist?

"CERTAINLY, IF THAT IS YOUR WISH, BUT I'D ALSO LIKE TO SPEAK WITH YOUR PRIVATELY AT SOME POINT."

Parents report 3 y/o has not begun to talk. Since birth child has been distractible. Also report child seems to have problem empathizing with siblings. What question should the Psych MD ask first? (2x)

"HAS YOUR CHILD'S HEARING BEEN TESTED?"

During an initial office evaluation, the pt tells the psychiatrist, "my spouse told me I had to be evaluated." Which of the following would be the most empathic response?

"HOW DO YOU FEEL ABOUT THAT?"

Pt w/ BMD who has been making progress in longEterm psychodynamic psychotherapy enters session obviously distraught. After listening to scattered seemingly unimportant details of recent daily life, therapist asks if pt is avoiding something too uncomfortable to talk about. Pt responds w intense anger/distress. "I just heard you are getting a divorce, I am sick about it. Here I am counting on you to help me sort out my chaotic life and messedEup relationships, and you can't even keep your own marriage together! What are you, some kind of hypocrite? I think I should leave and find someone who knows what they're doing!" Best response for the therapist to make?

"I AM GOING TO NEED A MOMENT TO THINK ABOUT WHAT YOU'VE SAID AND ARE FEELING BEFORE I CAN RESPOND."

Pt in psychodynamic psychotherapy repeatedly asks the therapist personal questions. The therapist consistently explores the reasons for the patient's asking, and sometimes these explorations are fruitful. Regardless, the pt persists in pressing for "real answers". The therapist response at this point is what?

"I KNOW THIS CAN SEEM VERY FRUSTRATING, BUT THE FOCUS OF THE THERAPY SHOULD BE ON YOU".

Principle of confrontation:

"I THINK YOU'D RATHER TALK ABOUT YOUR JOB THAN FACE THE SADNESS YOU FELT IN OUR LAST SESSION"

Exchange during initial interview after pt's former therapist closed his practice: pt expresses concern about new therapist being too young/inexperienced, states she doubts new therapist can provide any new insights. Best response to further goal of getting to know pt, establish whether therapy w new therapist would be appropriate

"IT CAN BE VERY HARD TO START OVER WITH A NEW THERAPIST. HOW HAVE YOU BEEN FEELING ABOUT HAVING TO END YOUR TREATMETN WITH DR. BROWN?"

3 y/o boy wants to play with his mom, but she is tired and it is naptime. What explanation would he best understand?

"IT'S NAPTIME NOW."

College student tells psychiatrist "I had an exam today and I'm sure I failed it. Now I will never graduate from college". Which response is consistent with CBT?

"LET'S MAKE LISTS OF THE EVIDENCE FOR AND AGAINST YOU FAILING OUT OF COLLEGE"

Treating a much older pt who asks about therapist's age. Best response:

"MAYBE YOU'RE CONCERNED ABOUT WHETHER I AM EXPERIENCED ENOUGH TO TREAT YOU?"

What has been found regarding infants' attachment to their parents?

"STRENGTH OF INFANT'S ATTACHMENT IS A FUNCTION

Pt reports assassins enter room, rape and threaten her every night. Reports "police think I'm making it up, you believe me right?" What is most appropriate response?

"WELL, FROM WHAT YOU ARE TELLING ME IT SOUNDS TERRIFYING"

What is most important to evaluate "competence"? (2x)

"WHAT DO YOU THINK WILL HAPPEN IF YOU DON'T UNDERTAKE THIS TREATMENT?"

F psychiatrist has been treating a 32 y/o married F pt w weekly individual psychotherapy for depressive sx, ambivalence about marriage. Therapy progressing well. Pt just learned she is pregnant, explores conflicted feelings about terminating pregnancy and her fears that unplanned pregnancy would trap her in marriage. Uncharacteristically, psychiatrist speaks strongly to pt about reasons not to mak such a choice. Pt responds by saying "you are not going to make me feel guilty about this!" What statement would be most appropriate for therapist to make in response?

"YOU FELT I WAS IMPOSING A MORAL JUDGMENT ONTO YOU, AND, APPROPRIATELY, YOU OBJECTED."

Psych MD is attending a seminar when a colleague states, "I heard you are treating Mr. X. I am so glad to hear it, because I know he's been having a lot of trouble and I am sure that you can help him a lot." Most appropriate response?

"YOU KNOW, FOR CONFIDENTIALITY PURPOSES I CAN'T REVEAL WHO I SEE OR DON'T SEE."

Example of empathic comment

"YOU MUST FEEL TERRIBLE RIGHT NOW."

When is there highest risk of suicide in MDD patients recently dc'd from hospital?

0E3 MONTHS AFTER DC

Investigators wish to maximize the probability of correctly rejecting the null hypothesis. This probability is referred to as:

1 MINUS BETA

What age can infant recognize mothers face as distinct from other faces?

1 MONTH

Earliest age infant likes to look more at strongly patterned shapes like faces?

1 WK

Federal eligibility requirements for maintenance treatment with methadone specify that an individual must have been dependent on opioids for at least what length of time?

1 YEAR

Lifetime prevalence of schizophrenia

1%

Risks of complicated bereavement:

1) AMBIVALENT RELATIONSHIP TO DECEASED; 2) SIMULTANEOUS GRIEVING FOR MULTIPLE DEATHS; 3) PREEEXISTING LOW SELFEESTEEM & INSECURITY; 4) RECURRENT MAJOR DEPRESSION

29 y/o recent immigrant from China believes his penis is shrinking; concerned he might die once his penis retracts into his abdomen. 1) What type of d/o is this? 2) What is best treatment?

1) CULTUREEBOUND SYNDROME 2) SUPPORTIVE THERAPY

Prevalence rate of suicide in general adolescent population?

10%

At what age do children begin to guide their actions in ambiguous situations using cues from the mother's facial expression or in her tone of voice?

12 MONTHS

Social referencing is generally evident at age:

12 MONTHS

A child with cancer achieves remission after undergoing extensive and multiple treatments. Two years later, the child develops a recurrence of the cancer that is unresponsive to treatment. The child says, "I'm dying. I just want to be at home with my mom, my dad, and my sister." At what age would the child most likely be to have this response to this situation?

14 YEARS OLD

Lifetime prevalence rate for ETOH abuse and dependence

15%

What is prevalence of Alzheimer's in >85 y/o?

16E25%

65 y/o pt initially diagnosed w bereavement. Duration of sx to dx MDD?

2 MONTHS

The age at which children typically first use sentences of 2 or more words is:

24 MONTHS

Core gender identity is typically established by what age? (2x)

3 YEARS

Carbamazepine should be D/C'ed if the absolute neutrophil count is below: (2x)

3,000

African americans tend to have higher activity of which of the following cytochrome p450 enzymes?

3A4

Children should play together with social interaction and role playing by what age?

4 Y/O

Stable, steady state Lithium levels are generally obtained within:

4E5 DAYS

Minimum recommended washout period for fluoxetine prior to starting MAOI (2x)

5 WEEKS

Risk that a subsequent child will be autistic in a family with one autistic child is:

5%

Buspirone is thought to exert anxiolytic effects primarily due to its actions at which receptor?

5HTE1A

Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long?

6 MONTHS

A child recently becomes adept at running and jumping, in using a pincer grasp, and knowing the day and year is most likely to be at what age?

6 YEARS OLD

What avg dose range of methadone yields best results in decreasing illicit use? (3x)

60c100MG

An individual with a full scale IQ of 65 could be expected to plateau at what level of academic functioning?

6TH GRADE

IQ scores generally considered to be stable beginning at:

7 YEARS OLD

The formation of small peer groups who share values, speech patterns, and manners is first seen around what age?

8 YEARS

What risk management strategy for dealing with a pt with SI is most likely to be rejected as invalid in a subsequent malpractice lawsuit?

A "NOEHARM" OR SUICIDE PREVENTION CONTRACT BETWEEN THE PT AND THE THERAPIST.

Twin studies of patients with schizophrenia have consistently identified substantial proportions of monozygotic twin pairs that are discordant for the illness. The most likely explanation is:

A "TWOEHIT" MODEL OF PATHOGENESIS EXISTS IN WHICH PREDISPOSING ENVIRONMENTAL FACTORS COMBINE WITH GENETIC RISKS

An example of parallel play: (2x)

A 2 YO CHILD SITS NEAR ANOTHER TODDLER WITH A TRUCK AND PICK UP A CAR.

16 y/o caught for shoplifting jeans. No hx of stealing, jeans not her size. Pt frightened, remorseful, insomnia, failing grades, avoiding friends. Raped 2 months earlier, family insisted she not tell anyone. Understand stealing as:

A CRY FOR HELP

A pt reports, "undercover agents are all there, and they're gonna kill me." Pt's comment is best described as:

A DELUSION

In order to be judged competent to stand trial, a defendant must be able to consult with the lawyer w/ a reasonable degree of rational understand and possess what?

A FACTUAL AND RATIONAL UNDERSTANDING OF PROCEEDINGS AGAINST HIM/HER

Which of the following describes core narcissistic character pathology according to Kernberg's model?

A FUSION OF THE IDEAL SELF, THE IDEAL OBJECT, AND THE REAL SELF RESULTING IN THE DEVALUATION OF OTHERS

When evaluating a patient in the ED for risk of dangerousness to others, the best predictor of future violent behavior is:

A HISTORY OF VIOLENT BEHAVIOR

A patient repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. The patient also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing selfEpsychology would be most likely to interpret this due to which of the following factors?

A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHY FROM CAREGIVERS

Which of the following patients would automatically be considered as lacking the capacity to give informed consent for medical procedures?

A PATIENT WITH ALZHEIMER'S DEMENTIA WHO HAS A STATE DESIGNATED GUARDIAN

25 y/o F never on a date after 6 mo of psychodynamic psychotherapy. Began to struggle w/ positive feelings about M therapist that she finds hard to accept. At the same time she starts to date. Therapist believes it is transference. Therapist said nothing, he believed an interpretation might interfere w/ positive learning experience. This is example of:

A PRACTICAL/SUPPORTIVE APPROACH

What most seriously threatens the external validity of a research study? (2x)

A STUDY POPULATION THAT IS NOT REPRESENTATIVE OF THE POPULATION TO BE TREATED

Psychiatrist who uses network therapy to treat patients with addictive disorders is functioning as:

A TEAM LEADER

32 y/o pt is considering a course of hypnosis to help quit smoking, but voices concerns. Pt expresses worry about potential harm of hypnosis if not done properly. What would be the best initial response for the psych MD to make to pt regarding this concern?

A TRANCE PROCEDURE IS BENIGN AND REVERSIBLE BY CALM REASSURANCE

Adolescent who was previously getting along with parents is now becoming more resistant to parental control and insistent about making his own decisions about daily life. Feeling irritated with parents and guilty after minor arguments. Feelings of guilt are likely explained by?

A WISH TO SEVER THE PARENTECHILD RELATIONSHIP

Cognitive therapy was developed by:

AARON BECK

Pt attempted suicide during a crisis which was worsened by pt's feelings about being unable to reach vacationing psychiatrist who did not provide coverage. What is the psychiatrist's vulnerability?

ABANDONMENT

Pregnant women involved in a DV relationship get struck where most commonly? (5x)

ABDOMEN

Pt who has been treated with lithium for bipolar shows a good response in stabilization of mood, but reports feeling dull, slow, and unable to concentrate. Lithium side effect?

ABSOLUTELY!

Common experience of becoming so caught up in a movie that one ignores the environment is example of what component of hypnotic process?

ABSORPTION

During a hypnosis session a pt reports reduced awareness of sounds and other distractions in therapist's office. Pt report is reflective of which of the following components of hypnotic concentration

ABSORPTION

Asking a pt, "which one does not belong in the following group: 13 pennies, a piggy bank, and a cow?" is a test of which domain:

ABSTRACT REASONING

Asking the patient "how are an apple and an orange alike?" assesses which of the following cognitive functions?

ABSTRACT REASONING

What signifies the ability to shift back and forth between general concepts and specific examples? (2x)

ABSTRACT REASONING

Wisconsin card sorting test (WCST) assesses (2x)

ABSTRACT REASONING AND FLEXIBILITY IN PROBLEM SOLVING

Asking a patient to interpret the phrase "Don't cry over spilled milk" tests what?

ABSTRACT THINKING

Process by which children modify existing schemas to adapt to new experiences is:

ACCOMMODATION

Unconscious thoughts that do not maintain logical connections

ACCORDING TO PSYCHOANALYTIC THEORY, THE TERM PRIMARY PROCESS THINKING REFERS TO MENTAL ACTIVITY EXEMPLIFIED BY WHICH OF THE FOLLOWING?

30 y/o MD who has emigrated from China to the US continues to take pride in family recipes, but has recently embraced American ballroom dancing. This represents which of the following:

ACCULTURATION

Which of the following is the core strategy when initiating treatment of hostile pt

ACKNOWLEDGE & VALIDATE THE PATIENT'S AFFECT

Interview w/ a pt w/ schizophrenia evokes feelings of confusion and frustration in the interviewer when the pt becomes silent. What response by the therapist would be the best approach to establishing rapport?

ACKNOWLEDGING THE INTERVIEWER'S FRUSTRATION AND INQUIRING IF THE PT FEELS SIMILARLY

Pt in group therapy calls another patient at home to object to something said in session

ACTING OUT

In CBT, ask patient to keep log for each hour and rate sense of mastery and pleasure experienced. What is this?

ACTIVITY MONITORING

Psychological function of a medication

ACTS AS A CONTAINER FOR THE PATIENT'S PROJECTED ANXIETIES ABOUT BEING DEFECTIVE

Intensive, shortEterm dynamic psychotherapy is contraindicated for what condition?

ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA

Two wks after beginning a strict diet, a 24 y/o patient has abdominal and limb pain. He is anxious, pale and tachycardia on exam. Unable to orient and seems to be responding to hallucinations. This happened in the past. Dx? (2x)

ACUTE INTERMITTENT PORPHYRIA

Pt with multiple past med trials reporting extensive SEs with those meds has been started on fluoxetine and now reports severe sweating. Pt's depression and anxiety have significantly improved on 10mg daily but pt reports "my bedding is drenched every day when I wake up". Most appropriate next course of action?

ADD TERAZOSIN TO PT'S MED REGIMEN

35 y/o pt w/ severe depression with episodes of anxiety for past 9 months. Pt has severe weight loss, hyperpigmentation of exposed skin, and cold intolerance. Dx:

ADDISION DISEASE

Primary focus of a cognitive therapy approach to suicidal behavior:

ADDRESSING ALL OR NOTHING BELIEFS AND HELPING PT LEARN PROBLEM SOLVING

Which is listed on President's New Freedom Commission on Mental Health (2003?) (2x)

ADDRESSING MENTAL HEALTH AS VIGOROUSLY AS PHYSICAL HEALTH

The effects of caffeine on which of the following results in increased dopaminergic activity?

ADENOSINE RECEPTOR

Schizophrenic on haldol 5mg presents to ED "unable to see." Appears distressed, writhing and moaning. States "I'm unable to stop looking up." What is the best treatment?

ADMINISTER BENZTROPINE 1MG IV NOW

20 y/o pt brings 2 y/o child to ER with multiple bruises. Mother says he fell down stairs. Mother has healing black eye and cut lip. Says she slipped on ice and hit head. XEray of child's arm show hairline fx and healing callous. What action should psychiatrist take first?

ADMIT CHILD FOR CARE AND PROTECTION DESPITE MOTHER'S OBJECTIONS

50 y/o pt presents to the ER voicing suicidal thoughts. The pt states the intent to kill himself with a gun in the woods behind his house. Best course of action is to:

ADMIT THE PT TO THE HOSPITAL FOR FURTHER ASSESSMENT AND CARE.

Child w IQ of 68 will likely have adjustment issues and struggles w which developmental stage?

ADOLESCENCE

Developmental stage in which brain is experiencing pruning of half of its synaptic connections, a decline in glucose and oxygen metabolism and decrease in EEG amplitude:

ADOLESCENCE

The capacity to set reasonable goals for one's self and to accept one's imperfections and others limitations is typically first realized during which developmental stage?

ADOLESCENCE

The stage of life in which consolidation of a personally acceptable sexual identity generally occurs is called?

ADOLESCENCE

Why don't twin adoption studies have methodological limitations?

ADOPTEES ARE NOT A REPRESENTATIVE POPULATION SAMPLE.

Adoption research in one method to delineate genetic versus environmental influences on phenotype. The limitation of this approach:

ADOPTEES ARE NOT REPRESENTATIVE SAMPLE AND ADOPTIVE AND BIOLOGICAL PARENTS MAY RESEMBLE ONE ANOTHER.

What research design best clarifies the role of environment in behavioral genetics?

ADOPTION STUDY

36 F with easy fatigue, weight loss, craving salt, nausea, hyperpigmentation, and muscle cramps. Pt noted to have a mod depressed mood and appears apathetic. Dx?

ADRENAL CORTICAL INSUFFICIENCY

What conditions associated w MR have an autosomal recessive inheritance pattern?

ADRENOGENITAL SYNDROME, HURLER'S, TAYESACHS, PHENYLKETONURIA

In the US, most needs of dependent elderly patients are fulfilled by which of the following individuals or agencies?

ADULT CHILDREN

Which tools can be used when a person wishes to assign a surrogate to make health care decisions during future periods of mental incapacity?

ADVANCE DIRECTIVE

What response would be based on a purely laisonal model of psychosomatic medicine give for a pt who may be depressed?

ADVISE THE TEAM ON HOW TO PROPERLY DIAGNOSE DEPRESSION

On the expressiveEsupport spectrum of therapeutic interventions, which is considered the most supportive therapy intervention:

ADVISING

Psych MD is approached at social gathering by a neighbor who seeks advice about recent Sx of depression and anxiety that neighbor has experienced since being fired from work. Which action would constitute establishment of doctorEpt relationship?

ADVISING NEIGHBOR TO START CBT W ONE OF SEVERAL PROVIDERS

GagErule clauses in some managed care plans may prohibit docs enrolled in their plans from taking which action?

ADVISING PTS ABOUT TREATMENTS NOT COVERED BY HMO

A 5 year old child whose mother was in a minor car accident believes he is responsible for causing the accident because he yelled "I hate you" in protest when his mother left him with a baby sitter an hour earlier. This belief represents which of the following?

AGE APPROPRIATE EGOCENTIC THINKING

A Caucasian pt with what risk factors has the highest risk for completed suicide in the US?

AGE GREATER THAN 85 YEARS

Which is a consistently identified risk factor for suicide that is unique to adults with schizophrenia compared to the general population?

AGE LESS THAN 35 YEARS

Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on? (4x)

AGGRESSIVENESS

Programmed practice, or exposure therapy, is an indicated treatment for what disorder?

AGORAPHOBIA

End stage AIDS with worsening fine motor movement, fluency, and visual spatial coordination, Dx? (2x)

AIDS DEMENTIA COMPLEX

Periodically assess neuroleptic side effects using? (it also shows pt's awareness of side effects) (2x)

AIMS

What manifestations is the most common side effect of conventional antipsychotic meds?

AKATHISIA

Which of the following caregiver characteristics is the strongest predictive factor for elder abuse? (2x)

ALCOHOL ABUSE

What is the most common biological cause of prenatal neurotoxicity linked to the development of intellectual disability (mental retardation)?

ALCOHOL EXPOSURE

A person's inability or difficulty to describe or be aware of emotions or mood is called: (4x)

ALEXITHYMIA

Poverty of speech and poverty of content are aspects of which of the following conditions?

ALOGIA

Orthostatic hypotension associated with TCA's is caused by blockade of what receptor?

ALPHAE1EADRENERGIC

Clonidine mechanism of action:

ALPHAE2 AGONIST

Substance useful for male erectile dysfunction when administered either transurethrally or by intracarvernosal injection?

ALPROSTADIL

Biological consequences of psychological stress are documented to affect...

ALTERATION OF NEUROEIMMUNOEENDOCRINE FUNCTION

Term "endophenotype" refers to what phenomena in behavioral genetics?

ALTERNATE EXPRESSED FORMS RELATED TO A DISEASE

According to sociobiologic theory, what term describes behaviors at the level of the individual that maximize fitness at the level of the gene?

ALTRUISM

60 yo pt with chronic schizophrenia takes cogent in for neuroleptic induced parkinson now has increased urine retention and confusion. What medication would be the best alternative for treating this patient's condition?

AMANTADINE

Schizophrenic OD'd on antipsychotics, has EPS and urinary retention. Tx?

AMANTADINE

Li induced polyuria tx with least effect on Li level?

AMILORIDE

Which med can decreased serum concentration of lithium

AMINOPHYLLINE

Do NOT use in pt w/ narrowEangle glaucoma

AMITRIPTYLINE

Dry mouth, blurred vision, constipation, urinary retention. S/E of what psychotropic?

AMITRIPTYLINE

Nortriptyline is the active metabolite of which of the following TCAs?

AMITRIPTYLINE

Which antidepressant is successfully used to treat pain syndromes?

AMITRIPTYLINE

Pts on chronic benzos develop:

AMNESIA

Vocabulary growth and preEliteracy language skills in preschoolers appear to be most associated with:

AMOUNT OF TALK DIRECTED TO THE CHILD

Which TCA should be avoided in pts w/ Parkinson's?

AMOXAPINE

Polymerase chain reaction (PCR) used in genetic linkage studies involves:

AMPLIFICATION OF MICROSATELLITE MARKERS

Company X develops new medication for depression. Although the initial trials reveal only modes, statistically insignificant mood benefits, the research team decides to analyze the drug's effects in subgroups. By subgrouping the subject pool into 20 subgroups, the researchers find statistically significant mood benefits for men/women w birthdays in the early fall. Conclusion that can be drawn from finding is that it is:

AN ARTIFACT OF MULTIPLE ANALYSES

Medication can be administered without a patient's consent under which of the following circumstances? (2x)

AN EMERGENCY SITUATION EXISTS AND CAN BE DOCUMENTED

What documentation will legally protect a psychiatrist, if pt dies by suicide?

AN SUICIDE RISK ASSESSMENT AND PROTECTIVE FACTORS.

A previously healthy 65 yo patient presents to a psychiatrist with newEonset AH. The psychiatric evaluation of this patient should initially focus on uncovering:

AN UNDERLYING MEDICAL CONDITION

33 y/o pt in long term psychodynamic psychotherapy for several months is chronically late for sessions. Therapist suggests that this may be resistance. The pt says "oh, don't take it personally, I am this way with everyone". This response can be best understood as:

AN UNINTENDED CONFIRMATION OF THE PROBABLE CORE SIGNIFICANCE OF THIS BEHAVIOR.

Which of the following terms was developed by Rene Spitz to describe a common outcome following sudden or prolonged separation of otherwise normally attached infants?

ANACLITIC DEPRESSION

Classical psychoanalytic theory says pleasure an adult might take in controlling others/making order of chaos relates to which psychosexual stage of development?

ANAL RETENTIVE

Differential Dx in a 6 y/o with daily fecal soiling includes:

ANAL STENOSIS, HYPOTHYROIDISM, HIRSCHSPRUNG'S DZ, SMOOTH MUSCLE DZ

Groups of pts w/ MDD, dysthymic d/o, and adjustment d/o were given mood scales. In order to compare the means of scores of these three groups, most appropriate statistical methods is: (3x)

ANALYSIS OF VARIANCE

Karyotyping is a method of genetic analysis characterized by which technique

ANALYZING CHROMOSOMAL STRUCTURES

Karyotyping is a method of genetic analysis characterized by which techniques?

ANALYZING CHROMOSOMAL STRUCTURES

A child with modEsev mental retardation wakes frequently at night, claps at inappropriate times, and has bouts of paroxysmal laughter. Syndrome?

ANGELMAN'S SYNDROME

3 y/o girl hurts herself w/ a tricycle. Then she hit the tricycle and asks, "Why did you hurt me?" Which thought process does this behavior exemplify?

ANIMISM

When toddler attributes a symbolic meaning to stuffed animal (e.g. teddy bear), imbuing it with the quality of being alive, this is referred to as:

ANIMISM

Psych MD sees 62 y/o pt who has been hospitalized after an acute MI because staff report that "the pt is driving us crazy." The nurses complain that pt is constantly requesting info about his condition and treatment, and will refuse tests and medications if he feels the explanations are not sufficient. On interview pt admits that "I am a perfectionist" but is proud of this fact, saying that it is "the secret of my success." Pt is aware of the staff's frustration, but feels his requests for information are reasonable. The best advice to the Tx team?

ANSWER THE PT'S QUESTIONS AND ACTIVELY INVOLVE THE PT IN ALL PORTIONS OF HIS TREATMENT

45 y/o still grieving for mother 3 years after her death. States she feels her mother hovering over her and sees mother at night. Friends are concerned. Patient has normal job function, cleans house, endorses anhedonia. Tx?

ANTIDEPRESSANT MEDICATION AND PSYCHOTHERAPY

In addition to benzos, which class of meds is assoc with falls in pts older than 60?

ANTIDEPRESSANTS

A therapist plans to create a new outpt psychotherapy group should exclude from group participation Pt w/?

ANTISOCIAL PERSONALITY DISORDER

Autism spectrum disorders in children and adolescents are most highly comorbid with which of the following types of disorder?

ANXIETY

In preschoolEage children isolated hallucinations are common with:

ANXIETY

The infant temperament studies of Kagan and colleagues found strong correlation between early behavioral inhibition and subsequent development of d/o's in the area of:

ANXIETY

Highest prevalence psych d/o?

ANXIETY DISORDERS

32 y/o F w mixed anxiety/depression working well in supportivecexpressive psychotherapy once weekly for past 3 months. Focus on issues related to childhood neglect/abuse she experienced, how these impact current relationships. In one session, silent/tearful. With encouragement from therapist, reports her 18cmonthc old daughter hospitalized w meningitis; she is upset, worried. Therapist listens silently. Pt leaves session early, misses next session. Following time, she is angry, accuses therapist of being uncaring/insensitive for not expressing concern about her child/empathizing w her distress. Therapist's immediate response should be? (2x)

APOLOGIZE AND ACKNOWLEDGE THAT THE SILENCE HAD FELT HURTFUL TO THE PATIENT

Pt seeing new psychotherapist weekly x3 wks hesitantly complained about being able to overhear much of what pt in the preceding session was saying. Pt assured therapist that he had tried not to listen and had left the waiting room to wait outside until the other pt had left. Which is best response?

APOLOGIZE FOR THE LACK OF PRIVACY AND INDICATE THAT FUTHER MEASURES, SUCH AS MUSIC SYSTEM IN THE WAITING ROOM, WILL BE UTILIZED

What dopamine agonist has been used to treat pts with erectile dysfunction?

APOMORPHINE

Normal loss of 25E40% of neurons in fetal brain in the 2nd half of gestation is called:

APOPTOSIS

What is the mechanism for regulating cell production and elimination of inappropriate axonal connections in the developing brain?

APOPTOSIS

Most commonly reported SE of stimulants in kids (2x)

APPETITE SUPPRESSION AND SLEEP DISTURBANCES

In ethics, beneficence is: (5x)

APPLYING ONE'S ABILITIES SOLELY FOR THE PATIENT'S WELLcBEING. PHYSICIAN ACTS PATERNALISTIC

The criminal defendant tells the psychiatrist doing a forensic eval "I know that killing my father was illegal." However, the defendant delusionally believed that the father was being tortured by demons and killing him was the moral thing to do. The defendant is unable to do what?

APPRECIATE THE WRONGFULNESS OF HIS CONDUCT

Which of the following most accurately describes an important characteristic of friendships during midlife?

ARE LESS DEPENDENT ON BEING CLOSE IN AGE

78 y/o pt with Alzheimer's dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenially with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?

ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.

Most frequent cause of death following TCA overdose: (2x)

ARRHYTHMIA

Metachromatic leukodystrophy associated w/ mutation in gene for which enzyme? (2x)

ARYL SULFATASE

10 y/o M s/p MVA sustained burn and crush injuries to R foot 4 days ago, does not remember the accident but never lost consciousness, keeps asking for his mother who was killed in the accident and having nightmares crying out "Daddy help Mommy." When should the child be told about his mother's death?

ASAP

Initial psychiatric intervention for 50EyearEold married man with ED during sex but normal masturbatory ability, otherwise good marriage, and normal evaluation by PCP?

ASK PT TO BRING WIFE TO DISCUSS BEHAVIORAL EXERCISES

20 y/o western trained psychiatrist of northern European descent has been asked to treat a 40 y/o Hindu patient who emigrated to the US 2 years ago. The patient presents with complaints of weakness, fatigue, headaches, insomnia, palpitations, and decreased appetite. The patient also reports a 5 lb weight loss over the last month, dysphoric mood with intermittent anxiety, and suicidal ideation. In addition to assessing the patient's level of suicidality, it would be appropriate for the psychiatrist to do which of the following when beginning treatment? (2x)

ASK THE PATIENT WHAT HE BELIEVES EXPLAINS THE SYMPTOMS

A researcher develops a new questionnaire on the subject of traumatic stress. Which of the following actions would be most appropriate to test the measure's content validity?

ASK TRAUMA EXPERTS TO EVALUATE ITS RELEVANCE AND COMPLETENESS

7 y/o M w/ poor social skills, cognitive, but language wnl. Dx

ASPERGER'S SYNDROME

8 y/o boy has marked social delay, difficulty maintaining relationships d/t odd interpersonal style, preoccupied with small electronic devices, talks on and on about them, and excludes other age appropriate interests, has difficulty w/ transitioning from one activity to another, has poor eye contact, and oblivious to personal space. DX?

ASPERGER'S SYNDROME

What overdose causes ringing in the ear, abdominal pain and metabolic acidosis?

ASPIRIN

29 y/o M pt with hx of CPS 8x hospitalization in 14 months, stopped his meds and is unable to take care of himself, becomes paranoid and stays on the street, eating out of garbage cans and his family is unable to support him anymore. The most appropriate intervention to decrease this pt's risk of future hospitalizations: (2x)

ASSERTIVE COMMUNITY TREATMENT

80 y/o pt with Alzheimer dementia who lives with a daughter is brought in for evaluation of increasingly combative behavior. The daughter would like to keep the pt at home if possible. What intervention would be most helpful in this situation?

ASSESSING FOR CAREGIVER BURNOUT

80 y/o pt with Alzheimer's dementia who lives with the daughter is brought in for evaluation of increasingly combative behavior. The daughter would like to keep the pt at home, if possible. Which of the following interventions would be most helpful in this situation?

ASSESSING FOR CAREGIVER BURNOUT

Determines if pt has ego strength for therapy

ASSESSMENT OF QUALITY OF RELATIONSHIPS

Dementia pt with durable power of attorney, decisions need to be made by?

ASSIGNED DECISION MAKER

If pt is incompetent to make decision and has durable power of attorney, treatment recommendations will have to approved by the:

ASSIGNED DECISION MAKER

Bilineal inheritance typically reflects which of the following evolutionary population genetic features?

ASSORTATIVE MATING

42 M becomes depressed after discovering his wife is having an affair. Pt describes anger at his wife, avoids talking to her. Admits to feeling that the wife's actions are his fault, that he is a failure as a husband. The pt notes that he has begun to dwell on his past failed relationships, as well as the divorce of his parents. Pt begins CBT for depression. Most appropriate target for this type of therapy in this pt?

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

42 y/o pt b/c depressed after discovering his wife is having an affair. Pt describes anger at his wife and avoids talking to her. He admits to feeling his wife's actions are his fault and that he is a failure as a husband. Pt notes he has begun to dwell on past failed relationships and the divorce of his parents. He begins CBT. The most appropriate target for this type of therapy would be the pt's:

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

A child w/ selective mutism is most likely to have difficulties in which area?

AT SCHOOL

The most appropriate time to discuss advance directive is:

AT THE TIME OF ADMISSION TO THE HOSPITAL

What cultureEbound syndromes would be Dx for a pt with of insomnia, HAs, anorexia, fears, despair, diarrhea, & anger?

ATAQUE DE NERVIOS

65Eyear old pt with hx of MDD, hyponatremia and lethargy is in need of an antiE hypertensive med. Which of the following would be the safest med to try given the pt's history?

ATENOLOL

Pt develops feelings of restlessness, an inability to relax, jitteriness, pacing, and rapid alternation of sitting and standing shortly after being started on a low dose of haloperidol. Addition of what medications would be most effective in managing these symptoms?

ATENOLOL

75 y/o pt with AD started on quetiapine 12.5 mg bid for agitation> according Omnibus Budget Reconciliation Act, the MD must: (2x)

ATTEMPT TO DECREASE OR STOP THE MED DOSE AT LEAST EVERY 3 MONTHS.

Computer assisted continuous performance testing is used to assess what?

ATTENTION

Researcher developing test for working memory in schizophrenics. In addition to measuring immediate memory, what else should test measure?

ATTENTION

Someone taking the Continuous Performance Test (CPT) is asked to press a key whenever any letter except "X" is displayed on the screen. The letter "F" is displayed and the patient fails to press a key. Most likely a problem with ...

ATTENTION

What does the clock drawing task test?

ATTENTION, VISUOSPATIAL, PLANNING, EXECUTIVE FUNCTION (NOT orientation)

9 y/o child bangs his hand on soft toy, setting up steady rhythm & smiling w pleasure. Mother falls into his rhythm & says "Kaaacbam, kaaacbam," with "bam" falling on the stroke & "kaaa" accompanying upswing of the arm. This is example of: (2x)

ATTUNEMENT

Caregiver's attempts to underscore child's feeling state (Stern)

ATTUNEMENT

Psych MD orders quetiapine 50 mg for an 82 y/o nursing home pt w/ dementia who has become severely agitated. Soon after, the psychiatrist receives a call from a family member who is concerned about the "black box" warnings associated with antipsychotics in the elderly. Which of the following is the most accurate information the psychiatrist could give the family member regarding the potential safety risks of this medication?

ATYPICAL ANTIPSYCHOTICS INCREASE MORTALITY; THIS MUST BE BALANCED AGAINST ANY POTENTIAL BENEFIT

Decreased attention to social cues is most common among children with:

AUTISM

Most useful instrument to assess a nonEverbal 3EyearEold child who plays alone in the corner, stacking/unstacking blocks?

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS)

Adolescent with recent SA is about to be discharged from hospital. The parents refuse a request to remove firearms from the house, stating, "I need firearms to protect my family and I will make sure they are secured." Which ethical principle CONFLICTS with the psychiatrist making a CPS report?

AUTONOMY

Forcing med on pt directly challenges which of the following?

AUTONOMY

Providing pts with an understanding of their disorders and options for treatment is honoring which of the following principles of ethics:

AUTONOMY

Compulsions & obsessions are related to development disturbance during which of Erikson's psychosocial stages?

AUTONOMY VS SHAME AND DOUBT

Achieving sense of selfEcontrol and free will, struggling between cooperation and willfulness (Erikson)

AUTONOMY VS. SHAME AND DOUBT

Eriksonian phase correspond w/ Freud's anal phase

AUTONOMY VS. SHAME AND DOUBT

Pattern of inheritance in Huntington's disease

AUTOSOMAL DOMINANT

Pattern of inheritance in Wilson's disease

AUTOSOMAL RECESSIVE

22 y/o experiences a earthquake (7.0) during a seminar. In the months that follow he develops fearful reaction to sudden or loud noises. Pt avoids classes in the same building that the seminar was in. What is the mechanism of the behavior? (2x)

AVERSIVE CONDITIONING

During an evaluation for competency to stand trial, a defendant tells the courtE appointed forensic psychiatrist about being involved in an unsolved crime. The psychiatrist should do what?

AVOID A DETAILED DESCRIPTION OF THE DEFENDANT'S PAST OFFENSE HISTORY

What is considered to be the dey component underlying the syx of selective mutism?

AVOIDANT BEHAVIOR

Psych MD who is conducting individual psychotherapy with a pt, and family therapy with the pt and family is at risk to violate the ethical guideline:

AVOIDING DUAL RELATIONSHIPS.

2.5 y/o observes mother take an apple from the refrigerator, mother briefly turns back to the child and beings eating, when mother turns toward child he animatedly grabs for the apple and say, "my apple, not Mommy's." This behavior is best described as which developmental achievements?

AWARENESS OF BEING A SEPARATE SELF

77 y/o pt w/ hx of BMD, stable w/ bupropion 300mg and valproic acid 1000mg Qday. Pt reports feeling less motivated than usual at work, able to concentrate, but taking longer to finish tasks. Denied sadness. HTN is well controlled. MMSE score 26/30. Pt has master degree. The most appropriate workup:

B12 AND HOMOCYSTEINE LEVEL

3 1⁄2 y/o girl has increasingly become interested in dressing up in her mother's clothes and shoes, with increased remarks about being a girl. It would be most consistent with a social learning theory explanation of psychosexual development to say that her behavior is:

BASED ON MATERNAL MODELING AND BEHAVIOR

The doctor and patient relationship is described as fiduciary relation is:

BASED ON TRUST

Researchers wish to study a group of students who were exposed to a terrorist attack in which some of their classmates were killed, and compare the students to other students who had not undergone such a trauma. For the study to be considered quasiE experimental, which of the following requirements must be met?

BASELINE DATA MUST HAVE BEEN COLLECTED BEFORE THE EVENT

Pts who are committed to psychiatric treatment institutions in most states are presumed to:

BE COMPETENT TO MAKE THEIR OWN DECISIONS

Most appropriate brief screening instrument that a pt can fill by him/herself at physician's office to screen for depression is (3x)

BECK DEPRESSION INVENTORY

The best time to obtain ECG in the treatment of children with TCA:

BEFORE TREATMENT, FOR ALL CHILDREN, TO ESTABLISH BASELINE

45 y/o pt who is in good physical health reports increased fatigue, decreased appetite, and an inability to take pleasure in usual activities. Pt is begun on fluoxetine 20mg/day, and pt's mood improves over the course of 2 weeks. However, pt now notes a new onset of anxiety symptoms, including restlessness in the arms and legs. Pt is observed to fidget and seems unable to sit still for the exam. Neurological exam: unremarkable. Which courses of Tx would be most appropriate?

BEGIN PROPRANOLOL 10MG TID

Pt w/ MDD has been unresponsive to prior trials with a TCA and SSRIs. Pt has 1st degree right bundle branch block and poorly controlled HTN. Pt w/ no SI. Next step?

BEGIN TX WITH PHENELZINE

With respect to Rotter's social learning theory, which of the following statements best describes having an internal locus of control?

BEHAVIOR IS SHAPED BY AN INDIVIDUAL'S EXPECTATION THAT IT WILL REALIZE A VALUED GOAL.

4 1⁄2 y/o child insists there is a small monkey who shares the child's room. He talks to monkey, asks others to converse with monkey and insists that monkey have a seat at dinner table. Parents ask if they should be concerned, best response:

BEHAVIOR TYPICAL FOR PRESCHOOLERS

A 5 yearEold bilingual child has progressive refusal to speak in public, being very talkative at home and refusing to speak throughout the day in his kindergarten class. He is diagnosed with selective mutism. What is the appropriate intervention?

BEHAVIORAL TREATMENT TO INCREASE THE CHILD'S TOLERANCE FOR SPEAKING IN PUBLIC

A child with autism is placed in a therapeutic foster home where a consistent response is made to a given action with the goal of improving the child's functioning. This technique derives from which of the following learning theories?

BEHAVIORISM

Psychic determinism is (2x)

BEHAVIORS RESULT FROM UNCONSCIOUS MIX OF DRIVES, DEFENSES, OBJECT RELATIONSHIPS, SELFcDISTURBANCES

According to Winnicott, which is an essential component of parenting infants?

BEING SENSITIVE TO THE CHILD'S INSTINCT FOR EXPLORATION AND GROWTH

Pt who suffers from a serious mental d/o is a defendant in a criminal matter. Even if pt understands the nature and objectives of court proceedings, pt may be found not competent to stand trial under:

BEING UNABLE TO ASSIST ATTORNEY IN THE DEFENCES

Individual w/ schizophrenia arrested after breaking into grocery store would be found incompetent to stand trial if s/he:

BELIEVES ALL LAWYERS ARE DEMONS AND REFUSES TO SPEAK TO THEM

9 y/o is evaluated for bedwetting several times a week. Child has never been completely dry. Which Tx modality is likely to be most effective?

BELL AND PAD

Paternalism can be justified by which of the following basic ethical principles:

BENEFICENCE

What ethical principle provides the most appropriate basis for psychiatric intervention in a mentally incompetent patient? (5x)

BENEFICENCE

This cardiovascular disturbance is most common for Lithium:

BENIGN T WAVE CHANGES.

What is the treatment of acute dystonia?

BENZTROPINE

6 y/o girl hosp for surgery to repair fracture sustained in MVA in which mother was injured & brother died. She reports seeing her brother in her room since accident, MSE is nml. Receiving Vicodin & Benadryl. What explains pt seeing brother?

BEREAVEMENT

62 y/o pt presents to psychiatrist requesting med for depression. Detailed hx reveals pt's spouse of 35 years died suddenly 6 wks ago. Since then, pt complains of frequent crying spells, decreased appetite without weight loss, and poor sleep due to middle of the night awakening. Pt continues to attend social engagements with friends and denies SI. Pt has family hx of depression, no hx of depressive episode in past. Dx:

BEREAVEMENT

62 y/o requests antidepressant. Spouse died 6 wks ago. Crying spells, decreased appetite, poor sleep. Continues to see friends, no SI. Fam Hx of depression, no prior depressive episodes (2x)

BEREAVEMENT; ASSURE PATIENT OF NO PATHOLOGY

Which med reduces the acute sx of neuroleptic induced akathisia? (2x)

BETA BLOCKERS (PROPRANOLOL, ATENOLOL)

What drug is useful in the Rx of urinary retention secondary to TCA therapy (5x)

BETHANECHOL

What best illustrates a double bind in a family? (x3)

BETTY'S PARENTS ENCOURAGE COLLEGE, BUT COMPLAIN THAT EXPENSES WILL BE A HARDSHIP FOR THE FAMILY

Couple has sought couples' therapy due to chronic episodic fighting. Solution focused therapist might make which intervention?

BETWEEN NOW & NEXT TIME, I WANT EACH OF YOU TO THINK ABOUT WHAT THE TWO OF YOU ARE DOING DIFFERENTLY IN TIMES OF NOT ARGUING

60EyearEold pt with liver dz presents with confusion. On exam pt has asterixis of hands and has elevated serum ammonia level. EEG is likely to show:

BILATERAL TRIPHASIC WAVES

In 1935 Dr Bob Smith a surgeon w alcoholism met and was helped by an individual seeking support for abstinence form EtOH while traveling for business. These two are considered the founders of Alcoholics Anonymous. Who is the other person?

BILL WILSON

Difference in the rate and extent to which a brand name vs a generic drug becomes available to the site of action, given the same dose and condition, is measured as:

BIOEQUIVALENCE

FDA requires that generics not be significantly different from the parent compounds in what way? (5x)

BIOEQUIVALENCE

The FDA requires that pharmaceutical companies demonstrate that a generic drug is not significantly different from the parent compound in which way?

BIOEQUIVALENCE

The firstEline treatment for retentive encopresis:

BIOFEEDBACK

According to contemporary psychoanalytic theory, from birth to 18 months, children experience an emerging "self" as a result of what event?

BIOLOGICAL PROCESSES AND BODILY SENSATIONS COME TO HAVE A PSYCHOLOGICAL MEANING

What diagnosis, considered in the absence of other comorbidities, is estimated to put one at highest lifetime risk for suicide?

BIPOLAR DISORDER

Children demonstrate a preference for the human voice and speech over other sounds at what age? (2x)

BIRTH

Which group children are at greatest risk for death resulting from child abuse?

BIRTH TO 3 Y/O OLD

Pt with which dx are most likely to engage in parasuicidal behaviors?

BORDERLINE D/O

Which personality d/o is most commonly found in pts w/ severe factitious d/o?

BORDERLINE PERSONALITY

Dialectical behavior therapy is utilized for:

BORDERLINE PERSONALITY D/O

Test to discriminate cognitive difficulties in Alzheimer's from those in depression

BOSTON NAMING TEST

Which of the following tests is used for assessment of expressive language?

BOSTON NAMING TEST

22 y/o pt presents to psych for treatment of "internet addiction." Pt noticed a pattern of increasing time pent on the internet, need for better computer equipment, and feelings of anger and dysphoria when unable to access the Internet. Explain concepts of tolerance and withdrawal in this syndrome?

BOTH TOLERANCE AND WITHDRAWAL TO INTERNET USE CAN DEVELOP

Most effective tx for "writer's cramp" (focal dystonia assoc w/ writing)

BOTULINUM TOXIN

Difference between a boundary violation and boundary crossing is? (4x)

BOUNDARY VIOLATIONS ARE CHARACTERISTICALLY EXPLOITATIVE

What theory is the basis of mentalizationEbased therapy?

BOWLBY'S ATTACHMENT THEORY

The first sign of puberty in a female is most commonly?

BREAST BUDS

Tx for med student w/ chronic anxiety and sense of inadequacy?

BRIEF PSYCHODYNAMIC THERAPY

This treatment goal is most specific to psychoanalytic psychotherapy:

BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS.

What is a sleep disturbance likely to occur after initiating a trial of an SSRI?

BRUXISM

Routinely informing pts about confidentiality limits is ex. Of what ethical skill? (6x)

BUILDING ETHICAL SAFEGUARDS INTO WORK

Culture bound in industrialized countries per DSM IV

BULIMIA

Which of the following laboratory tests is essential prior to prescribing lithium?

BUN AND CREATININE

Antidepressant less likely to cause sexual dysfunction: (2x)

BUPROPION

Antidepressant with low risk of weight gain

BUPROPION

Medication to treat hypoactive sexual desire d/o who are not depressed:

BUPROPION

What antidepressant has an FDA pregnancy use B rating?

BUPROPION

What antidepressant increases REM sleep?

BUPROPION

What meds could be helpful in the treatment of depression in persons over the age of 65 because it does not produce orthostatic hypotension: (2x)

BUPROPION

Which medication should be discontinued prior to ECT?

BUPROPION

Which of the following medications would be preferable for use in an anxious patient with pulmonary disease? (2x)

BUSPIRONE

28 y/o with BMDII wants to use phototherapy for depressive Sx treatment in winter. What should you advise?

CAN BE USED BUT REQUIRES VIGILANCE AND CAREFUL TITRATION OF DOSE

In considering safe sex practices for avoiding HIV infection, oral sex is best characterized by:

CAN RARELY TRANSMIT VIRUS

Question to ask when evaluating for immediate recall (3x)

CAN YOU REPEAT THESE SIX NUMBERS?

Hypnotizability most strongly predicted by

CAPACITY FOR IMAGINATION

Med that has potential to decrease methadone blood level: (2x)

CARBAMAZEPINE

What psychotropic can cause a decrease in benzo plasma levels? (6x)

CARBAMAZEPINE

Which med is contraEindicated with clozapine?

CARBAMAZEPINE

What condition is a relative contraindication to ECT?

CARDIAC ARRYTHMIA

Theorist introduced the concepts of introversion and extroversion:

CARL JUNG

Examining relationship between exposure to psychotropic during pregnancy and Epstein's anomaly between women with Epstein's anomaly and a group of women who had babies w/o this anomaly is an example of

CASE CONTROL STUDY

Public mental health clinicians who follow patients through all phases of treatment

CASE MANAGERS

Examine relationship between exposure and effect by comparing patients with effect to patients without effect, assessing for prior exposure. Type of study?

CASEECONTROL

19 y/o pt expresses the belief that she failed a recent midterm exam despite studying a great deal for the test. The patient is convinced that this means she will lose scholarship money and will need to drop out of college. The patient is an excellent student who is prone to excessive worrying. Her belief that she is going to have to drop out of college because she did poorly on the midterm exam is an example of which of the following types of distortion?

CATASTROPHIC THINKING

Pt with depression being treated with CBT tells psychiatrist about waking up and being worried about work. Pt has big project that is due in two weeks and is half done, but pt is sure work will not be finished on time. Example of which cognitive error?

CATASTROPHIZING

Based on epidemiological studies from 1994E2004, which groups has highest suicide completion rate?

CAUCASIAN AMERICAN MEN IN THEIR 60S

The rate of illicit drug usage in high school is highest among which groups in USA?

CAUCASIAN AMERICANS

1993 - highest rate of suicide in 75E84 y/o age group:

CAUCASIANEAMERICAN MALES

Attribution processes are defined primarily as individual:

CAUSAL EXPLANATIONS OF EVENTS AND PERSONAL EXPERIENCES

Identifying new routes home from work for alcoholic patient is example of which type of therapy?

CBT

Pt has severe stress and conflict at work, therapist identifies the problem of maladaptive responses based on rigid thought schemas and decides to target automatic negative thoughts through reality checking and guided association. What type of therapy is this?

CBT

CNS responses to fear stimuli are mediated chiefly through?

CENTRAL NUCLEUS OF AMYGDALA

A CNS structure that is likely to suffer permanent damage following lithium toxicity:

CEREBELLUM

Which nervous system structure is likely to suffer permanent damage from lithium OD?

CEREBELLUM

Which of the following situational and environmental factors is most clearly associated w/ increased inpatient assaults? (6x)

CHANGE OF SHIFT

What justifies using Valproate more commonly that lithium for BMD in pts > age 65?

CHANGES IN RENAL CLEARANCE MAKES LITHIUM DOSING PROBLEMATIC

72 y/o legally blind pt (2/2 macular degeneration) with VH and w/o any other psychotic, cognitive and mood d/o. (2x)

CHARLES BONNET SYNDROME

Which is used to evaluate the relative frequencies or proportions of events in 2 populations that fall into well defined categories

CHI E SQUARE

What situation requires the psychiatrist to step out of usual tx relationship to protect the pt or others from harm?

CHILD ABUSE

A broadcbased rating scale for psychiatric symptoms in children? (2x)

CHILD BEHAVIOR CHECKLIST (CBCL)

Myelination is completed in what developmental stages?

CHILDHOOD

Which of the following benzos has an active metabolite?

CHLORDIAZEPOXIDE

Which neurotransmitter system is the last to mature in the CNS of children and adolescents? (2x)

CHOLINERGIC

What is part of routine workup of child with mental retardation but without dysmorphic features or neurological findings?

CHROMOSOMAL ANALYSIS

ChildhoodEonset schizophrenia typically have a course described as:

CHRONIC AND UNREMITTING

28 y/o female w sore throat, muscle/joint pain, HAs, poor memory, poor sleep. Takes 1 day to physically recover after normal exertion. Flu 6 months ago. No family history of depression. No SI. Diagnosis:

CHRONIC FATIGUE SYNDROME

AIDS pt, progressive weakness of extremities over weeks. Distal sensory deficit for pinprick and vibration. Slow nerve conduction, but EMG shows no denervation

CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY

ECT is least likely to be effective for patients who have?

CHRONIC SCHIZOPHRENIA

Clozapine clearance decreased by

CIMETIDINE

Increases paxil concentration:

CIMETIDINE

Pt on methadone maintenance started taking a reflux drug and now is sedated. What med was recently added?

CIMETIDINE

On MSE, thought process with lack of goal directedness, excessive details, and difficulty with closure describes a thought pattern of:

CIRCUMSTANTIALITY

SSRI w/ no or mild inhibition of major P450 isoenzymes of 1A2, 2C9, 2C19, 2D6, 3A4

CITALOPRAM

Which of the SSRI antidepressants has the longest mean halfElife?

CITALOPRAM

Which of the following has the longest mean halfElife: citalopram, paroxetine, venlafaxine, fluvoxamine, trazodone?

CITALOPRAM

Pt is nonsensical but is rhyming. What is this called?

CLANG ASSOCIATION

Term for thoughts connected by sound/words rather than by their meaning and is classified as an impairment in thought process: (2x)

CLANG ASSOCIATION

In initial psych interview, pt frustrated that his last psychiatrist had brief visits & "just gave me another pill every time." Interviewing psychiatrist responds "so you would like your psychiatrist to listen & understand you before adjusting your meds."

CLARIFICATION

When practicing Davanloo's shortEterm dynamic psychotx, one must consistently...

CLARIFY AND RELENTLESSLY CONFRONT THE PT'S DEFENSES

Cocaine craving triggered by sight of crack house is ex of what type of learning?

CLASSICAL CONDITIONING

IV heroin user upon seeing the needle during a blood draw develops intense craving is an example of:

CLASSICAL CONDITIONING

Pt ate meat loaf then had a severe GI virus; develops a strong aversion to meat loaf.

CLASSICAL CONDITIONING

Pt undergoing chemotherapy. Commonly becomes nauseated and vomits in waiting room prior to the treatment. Reaction is ex of?

CLASSICAL CONDITIONING

Pt who was in frightening MVA, consults psychiatrist for fears of driving, made car travel impossible. Behavior intervention is planned: psychiatris will ride in traffic with pt and remain w pt until physical signs of fear diminished. What learning tx?

CLASSICAL CONDITIONING

Pt with cocaine addiction experiences cravings for cocaine whenever passing by a "crack house". This reaction exemplifies: (2x)

CLASSICAL CONDITIONING

Systematic desensitization is derived from

CLASSICAL CONDITIONING THEORY

10Emonth old infant becomes distressed when parents leave child w/ babysitter without affection. Which subsequent behavior pattern is likely?

CLINGY AND AVOIDANT TOWARD PARENTS

This is an effective pharmacologic treatment for symptoms of OCD?

CLOMIPRAMINE

Breakthrough panic anxiety in a patient treated with shortEacting benzodiazepines can be managed by switching the pt to what medication?

CLONAZEPAM

In ER, which symptoms most strongly suggest a general medical condition?

CLOUDED SENSORIUM

HIV seropositive pt w/ psychotic symptoms has an absolute neutrophil count of 950 cells/mm3. Pt is on zidovudine, lamivudine, and ritonavir. What antipsychotic would be contraindicated? (2x)

CLOZAPINE

Reduces the suicide rate in adults with schizophrenia:

CLOZAPINE

Superior efficacy for atypical antipsychotics over typical antipsychotics in the treatment of psychosis has been consistently demonstrated in what medications?

CLOZAPINE

What antipsychotic medication would be the best choice to avoid motor symptoms in Parkinson's disease?

CLOZAPINE

Which antipsychotic has least effect on prolactin?

CLOZAPINE

Which antipsychotic med is assoc with decreased psychotic sxs, decreased substance use, and increased abstinence in pts with schizophrenia and addictive d/o?

CLOZAPINE

Which neuroleptic has the weakest affinity for the dopamine D2Elike receptor?

CLOZAPINE

Correlation of plasma drug concentration with the clinical effectiveness is best established for which antipsychotics?

CLOZAPINE AND HALOPERIDOL

Genetic linkage studies investigates what in medicoEpsychiatric research:

COESEGREGATION OF GENES DURING MEIOSIS

Psychotic pt given haldol, acute laryngospasm. In addition to intubation, give:

COGENTIN

Psychiatrist asks "How many quarters are in $15?", examining what ability

COGNITION

Explains psychosexual in infants and children, paired with right hypothesis

COGNITIVE DEVELOPMENT - SEXUAL BEHAVIOR DETERMINED BY SELFEIMAGE AND GENDER IDENTITY

30 y/o morbidly obese pt refuses to change eating and exercise habits, "I'll worry about my health when I am 65." One month later his father, also obese, dies of a myocardial infarction. The now obvious disparity between pt's current behavior and knowledge of the circumstances surrounding his father's death is an example of which learning theory process?

COGNITIVE DISSONANCE

According to Aaron Beck, the primary defect in depression involves which of the following?

COGNITIVE DISTORTION

98. Schizophrenic w memory loss and slowed thinking, stable on clozapine, with poor response to halloo, zyprexa, geodon and abillify. What could improve the pt's symptoms

COGNITIVE REMEDIATION THERAPY

In a group who has met for 6 therapy sessions, one pt has spoken at significant length for past 4 sessions about irrelevant issues & group members have rallied against him. What therapeutic mechanism in group psychotx is being undermined?

COHESIVENESS

A group of researchers studied the temperament of a group of children at age 3 months, 2 years, 5 years, and 20 years to determine relationships between initial temperamental characteristics of children who eventually had psychiatric problems. This is an example of what type of study? (2x)

COHORT

What research design would be the most appropriate in establishing a causal relationship between childhood vaccination and onset of autism?

COHORT

What research study examines a group studied over a prolonged time period? (6x)

COHORT

Research suggests that the frequency of alcoholism in lesbians as compared to heterosexual women was greater only in lesbians over 55 years of age. Which of the following is considered to be the best explanation for this finding?

COHORT PHENOMENON RELATED TO SOCIOCULTURAL ISSUES

Type of study to determine relationship between risk factor and development of disease

COHORT STUDY

How should a psychiatrist handle an interview about the misbehavior of a prominent government employee?

COMMENT ON HUMAN BEHAVIOR GENERALLY, BUT REFUSE TO OFFER OPINIONS ABOUT THE SPECIFIC PERSON

Which of the following is a positive prognostic predictor of overall outcome for children with autism?

COMMUNICATIVE SPEECH BY AGE 5

Psychiatrist is developing a new questionnaire about traumatic stress. Which of following actions would be most appropriate to test the measure's construct validity?

COMPARE THE SCORE OF HURRICANE SURVIVORS TO THOSE WITH NO PRIOR TRAUMA

A researcher develops a new questionnaire about traumatic stress. ?ost appropriate to test the measure's criterion validity?

COMPARE THE SCORES WITH THOSE OBTAINED USING HAMILTON ANXIETY RATING SCALE (HAMEA)

The primary psychological task of schoolEage children is achieving:

COMPETENCE

Informed consent is NOT required in which of the following forensic evaluations?

COMPETENCY TO STAND TRIAL

Structural model of family therapy characterizes family as

COMPLEX SYSTEM COMPRISED OF ALLIANCES AND RIVALRIES

65 y/o pt w MDD has died by suicide. Pt had received tx from same psychiatrist x 5 yrs. Psychiatrist contacts the pt's spouse. Best way to communicate this?

CONCENTRATE ON ADDRESSING THE FEELINGS OF THE SPOUSE

Asking a patient to recite a series of numbers in reverse order is a standard test of:

CONCENTRATION

The purpose of asking a pt to start at 100 and count backwards by 7's is to measure which of the following?

CONCENTRATION

Which practice is common to all couple and family therapies and contributes to a therapeutic outcome?

CONCEPTUALIZING DIFFICULTIES IN RELATIONAL TERMS

What is the combination of several unconscious impulses, wishes, or feelings that are attached to a single dream image?

CONDENSATION

Psychiatrist calls pt at home; wife asks how pt is doing. What principle governs response?

CONFIDENTIALITY

The psych MD who released medical records and audiotapes of the treatment of the poet Anne Sexton to the author who was writing a biography after her death could have been criticized for violating what principle?

CONFIDENTIALITY

Risk factor that can adversely influence psych outcome of child after death of parent

CONFLICTUAL RELATIONSHIP W/ DECEASED PARENT

Experimental subjects were asked to make a judgment but gave a wrong answer in spite of knowing the right one because they didn't want to disagree with responses of other participants. This phenomenon is:

CONFORMITY

Without evident distress, pt calmly reports to the psychiatrist, "Since I was last here, my significant other dumped me." The doctor responds by pointing out the discrepancy between the pt's affect and the content described. This response is an example of:

CONFRONTATION

Flooding, graded exposure, and participant modeling:

CONFRONTATION OF ANXIETYEPROVOKING EXPERIENCES

Which Tx is contraindicated in initial treatment of pt experiencing domestic violence? (4x)

CONJOINT MARITAL THERAPY

In terms of group dynamics, the confirmation of reality by comparing one's own conceptualizations with those of other group members and thereby correcting interpersonal distortions is known as what?

CONSENSUAL VALIDATION

Initial step when child is referred for evaluation:

CONSENT FOR EVAL FROM GUARDIAN

8 y/o boy sees 2 bottles w same amount of liquid. The content of one is poured in shorter wider glass and the other to a longer narrow glass. When asked which has more liquid he says it's the same. According to Piaget he is exhibiting: (2x)

CONSERVATION

What is achieved in Piaget's stage of concrete operations?

CONSERVATION

4 y/o child upset when ice cream melts. 10 y/o puts it in freezer and tells him it will be ok. 4 y/o insists it is ruined. Piaget's concept of this is:

CONSERVATION (ALSO REVERSIBILITY)

Compared to preschoolEage children, a schoolEage child with normal language development will demonstrate what ability?

CONSTRUCTING SENTENCES WITH MULTIPLE CLAUSES

Pt's dementia progressed to the point that the pt's driving is affected. In addition to talking to pt, the MD should:

CONSULT STATE LAW ABOUT OBLIGATIONS FOR REPORTING THE PT'S CONDITION.

A demented patient who is driving problematically. What do you do?

CONSULT STATE LAW ABOUT REPORTING

In pts w/ recurrent depression, successful Tx with antidepressants should be followed by which Tx strategies?

CONT ANTIDEPRESSANT AT SAME DOSE

Tracking pt satisfaction for accrediting agencies is characterized as which types of administrative activity?

CONT QUALITY IMPROVEMENT

1Emonth post death of loved one. What would suggest a pathological grief rxn?

CONT. FEELINGS OF WORTHLESSNESS

29 y/o schizophrenic frequent ER visits and hospitalizations. Hallucinating, agitated, not violent or suicidal, cooperative. Ran out of meds a few days ago. Had been doing well on olanzapine for several months and was doing fairly well in structured living environment. Denies command AH. What should the next intervention here be? (3x)

CONTACT CASE MANAGER TO VERIFY ENVIRONMENTAL SUPPORT

Insurance company tells psychiatrist to switch generic drug. You know alternatives may be good too. What do you do?

CONTACT INSURANCE AND ASK FOR NONFORMULARY APPROVAL

6 y/o at school cries for mom, other kids start crying:

CONTAGION

During a group therapy session female pt describes past experiences of sexual abuse by her father. Pt states that at times she feels depressed and hopeless, and has intense thoughts of killing herself. Another pt in the groups states, "I feel the same way, and I've felt like this for a long time." Second pt's admission is reflective of which of the following therapeutic factors in group therapy?

CONTAGION

Researcher is reviewing a questionnaire to screen for MDD, notices that the questionnaire has no Qs pertaining to depressed mood but has a few Qs pertaining to spending sprees. What form of validity is most affected?

CONTENT

The extent to which an instrument represents the construct being measured is referred to as what type of validity?

CONTENT

Test for anxiety that does not include Qs about physical sx such as tachycardia and diaphoresis would be considered lacking in what?

CONTENT VALIDITY

Pt in methadone tx earns number of takechome doses based on compliance with attendance and participation in groups. What kind of intervention is this? (2x)

CONTINGENCY MANAGEMENT

Managed care org. asks MD to d/c a pt who still requires hospitalization. MD should:

CONTINUE ADMISSION AS LONG AS MEDICALLY NECESSARY

32 y/o F pt w/ BMD has been treated with lithium. Pt reveals to her psychiatrist that she is now pregnant. Attempts to dc lithium in the past have led to relapses of the pt's disorder, with severe associated morbidity. A trial of an antipsychotic in the past resulted in NMS, and pt has since refused to use them. Which of the following would be the best option for treatment during the pregnancy? (3x)

CONTINUE LITHIUM

Pt has not responded to adequate trials of SSRI, SNRI, TCA, MAOI, but feels improved with 8 treatments of ECT. What next?

CONTINUE MAINTENANCE ECT FOR AT LEAST 10 WEEKS

Pt w/ hx of MDD has been taking Fluoxetine 40 mg PO QDay for one year since achieving remission of third depressive episode. Pt wants to stop medication because of sexual side effects responsive to Sildenafil 100 mg PRN. What should psychiatrist recommend to pt?

CONTINUE THE FLUOXETINE AS LONG AS IT IS EFFECTIVE

Basic concept of community psychiatry

CONTINUITY OF CARE

Elements common to both CBT and eye movement desensitization and reprocessing in the treatment of patients with PTSD include:

CONTROLLED EXPOSURE TO TRAUMA RELATED TRIGGERS

Both mens era and acts reuse are required for which of the following?

CONVICTION OF A CRIME

ECT has increased complications in patients with what medical condition?

COPD

What is associated with a markedly increased risk of complications from ECT?

COPD

A pt with chronic motor and vocal tics makes recurrent obscene gestures which are intrusive and not related to the conversation or any stimuli in the environment. The gestures are best described as:

COPROPRAXIA

MD sees psychiatrist w increasing sense of dislike for a blaming, externalizing pt who pits family members against the MD. What should psychiatrist discuss w MD?

COUNTERTRANSFERENCE

Psych resident dislikes alcoholic pts and avoids working with them. In discussing the problem, says that pts are hopeless and unmotivated and she can't empathize with them. Example of? (2x)

COUNTERTRANSFERENCE

Woman is unable to achieve orgasm with her partner. Treatment = directed masturbation + ?

COUPLES THERAPY

NewEonset Erectile Dysfunction despite satisfactory sex life w/ wife. Preoccupied w/ job, arguing more. Normal past history. Tx:

COUPLES THERAPY (INSTEAD OF SOMATIC THERAPY)

Buprenorphine's advantages over clonidine, in the management of patients with opioid withdrawal, include better control of which of the following symptoms?

CRAVINGS

The therapist's initial tasks in starting supportive group therapy are deciding the logistics of organizing planned meetings and selecting patients who can participate in group work. Which of the following would be the appropriate action for the therapist to take next?

CREATE AND MAINTAIN A THERAPEUTIC ENVIRONMENT KEEPING IN MIND THE CULTURE OF THE GROUP

Initial tasks in starting supportive group therapy are deciding logistics and selecting patients. Next step:

CREATE AND MAINTAIN THERAPEUTIC ENVIRONMENT KEEPING IN MIND CULTURE OF THE GROUP

Which metabolic changes is characteristic of normal aging?

CREATINE CLEARANCE DECLINES

A patient who is prescribed a highEdose of fluphenazine develops a fever of 103 F, tachycardia and AMS. Which test is most likely to be helpful?

CREATINE KINASE

According to theories of infant socialization, successful attachment most likely promotes survival through which of the following?

CREATING A BOND SO THAT THE ADULT WILL PROTECT THE INFANT FROM DANGER

Autonomic instability, nonfocal neurological signs, and elevated temp associated with which elevated lab value?

CREATININE PHOSPHOKINASE (CPK)

Psych MD in the ER evaluates a 27 y/o pt with no past psychiatric history who presents with SI following an altercation w/ her boyfriend. The psych MD makes a diagnosis of adjustment disorder with mixed emotional features. What is initially most appropriate for the psych MD to recommend for this pt?

CRISIS INTERVENTION

Which of the following types of studies is best suited to determine prevalence? (2x)

CROSS SECTIONAL

normal or abnormal? "

CROSSECULTURAL GRIEF PRACTICES

A clinical trial will assess the impact of two atypical antipsychotic meds on glucose intolerance. Half of the participants will start on drug 1 and then be treated with drug 2, while the other half will start on Drug 2 then drug 1. What type of experimental design?

CROSSOVER DESIGN

After an injection with haldol, a patient appears tremulous, dystonic, confused, and has a fever of 38.8 degrees C. Which of the following would be an essential part of the diagnostic workup for this patient? (2x)

CSF EVALUATION

A Japanese family who recently moved from Japan brings their 6 yo child for an evaluation. They express concerns that the child appears depressed, is reluctant to go to school, and is fearful that harm will befall the parents. During the evaluation it is noted that the child sleeps in the same room as the parents. Which of the following is the most likely explanation of this sleeping arrangement?

CULTURAL NORM

When evaluating for competence to proceed in a criminal matter, the psychiatric evaluator should focus on which aspect of the defendant? (2x)

CURRENT MENTAL FUNCTIONING

Pt is seen by psychiatrist because has been depressed for 1 yr since he was fired in spite of having another job. The psychiatrist tells the pt: men often feel that they are not allowed any failures but I can tell that you have moved on from this successfully and have no reasons to dwell in it. The pt then withdraws. The most likely cause of pt response is that he felt:

CUT OFF BY THE PREMATURE OFFERING OF REASSURANCE

Following the initiation of postEtransplant medications, a pt who was hospitalized for a kidney transplant became tremulous and highly anxious, had trouble speaking and showed signs of psychosis with hallucinations. Which of the following medications is most likely to have caused the change in the patient's status?

CYCLOSPORINE

Strongest genetic contribution

CYCLOTHYMIC DISORDER

35 y/o F reports being happily married responds well to fluoxetine for depression. On followEup, complains of anorgasmia. Most helpful Tx?

CYPROHEPTADINE

Indication for treating a manic w/ ECT:

DANGEROUS LEVELS OF EXHAUSTION

Which research or statistical methodologies were used to develop the DSMEIVETR?

DATA REEANALYSES AND FIELD TRIALS

14 y/o Native American Indian girl brought to mental health center b/c she has visions of spirits. Tells psychiatrist spirits are elders who appear, give her advice. No hx substance abuse/mental disorder. Interview w parents reveals they are traditional & feel daughter's visions are a gift. But they are worried about schoolwork, which has deteriorated b/c she has been preoccupied with spirits. Tx should focus on:

DEALING WITH HER SCHOOL PROBLEMS

Beginning phase of therapy w child who was incest victim should first focus on what?

DEALING WITH PRIOR BETRAYAL AND ESTABLISING TRUST WITH THE THERAPIST

According to Holmes & Rahe, what life event is assoc w highest stress/disruption?

DEATH OF A SPOUSE

Across all cultures, what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years?

DEATH OF A SPOUSE

A 10 yo child remains sad and angry about his parent's divorce but no longer believes that he caused the separation. This cognitive change is example of what mechanism?

DECENTRATION

Most ethical response and reason when patient sends therapist a Facebook friend request

DECLINE; DISRUPTS BOUNDARIES OF THERAPEUTIC FRAME

Patient w/ ADHD is treated with stimulants and biofeedback. Late in the course of biofeedback, the pt exhibits increased irritability, moodiness, and hyperactivity. Best response?

DECREASE DOSE OF STIMULANT

60y/o on 6mg risperidone, 50mg sertraline. Slowed thinking, drooling, cogc wheeling, masked facies. Mood/paranoia improved on meds. What to do? (4x)

DECREASE DOSE OF THE ANTIPSYCHOTIC

Which of the following sleep changes is produced by all benzos?

DECREASE IN REM

36 y/o pt c/o dysphoria, insomnia, fatigue, poor concentration. Pt is started on sertraline 50mg, increased to 100mg in 2 weeks. 2 months after dose increase, pt reports mood greatly improved. However, pt notes new onset of sx of delayed ejaculation, frequently to point of anorgasmia. He believes this began almost immediately after dose increase. First step in management of problem would be?

DECREASE THE SERTRALINE DOSAGE TO 50MG/DAY

Changes in CSF in pts with IED

DECREASED 5HT LEVELS

Frequent episodes of falling asleep during daily activity is associated with which lab finding

DECREASED CSF HYPOCRETIN

Agitated pt gets rapid tranquilization in ED. Using oral concentrate instead of IM or IV has what advantage?

DECREASED FEELINGS OF HELPLESSNESS

Pts over 65 y/o are less likely to tolerate higher doses of antipsychotics due to:

DECREASED HEPATIC METABOLISM

Patients >65 y/o are more sensitive to psych meds. What physiologic change occurs with aging?

DECREASED PHASE 1 OXIDATION

Alcohol use is associated with what changes in sleep?

DECREASED REM SLEEP

In terms of the normal functioning of the personality, Anna Freud's contributions were in the realm of:

DEFENSE MECHANISMS

Supportive psychotherapy classically involves supporting and accepting the patient's:

DEFENSE MECHANISMS

10 y/o IQ 69. Findings that would confirm Dx of MR?

DEFICITS IN SELFECARE AND SOCIAL SKILLS

Most important finding for a psychiatrist to consider in disability determination:

DEGREE OF FUNCTIONAL IMPAIRMENT

Which is paraamnesia?

DEJA VU

Which is a symptom of autistic disorder but NOT of Asperger's?

DELAY OF SPOKEN LANGUAGE OR COMMUNICATIVE GESTURES

58 y/o have week's h/o intense feelings of sorrow and bitterness only 6 mos after wife's death. "We would have been married 30 yrs this month." His daughter confirmed his level of functioning only took a dip a week ago. Moderate diff sleeping and poor appetite only assoc Sxs. No SI. Physical exam normal. Dx:

DELAYED GRIEF

21 y/o pt is hospitalized w/ 4 wk hx of progressive paranoia, irritability, confusion and sleep disturbance. Psych MD elicits pt hx of viral illness preceding the onset of psychiatric Sx and mental status changes. No family psych hx. Benadryl markedly make Sx worsened. Dx

DELIRIUM SECONDARY TO VIRAL ENCEPHALITIS

• Designate pt as full code • Seek decisionEmaking surrogates • Deliver tx in pt's best interests "

DELIVER TX IN PT'S BEST INTERESTS

Changes w/ sleep associated with aging:

DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4

What is a poor prognostic sign for HIV?

DEMENTIA

In cases of recovered memory, the role of the therapist is to:

DEMONSTRATE EMPATHY FOR THE PATIENT WITHOUT ENDORSEMENT OF THE MEMORY

The basis for selfEpsychological strategy in marital therapy is best indicated by what?

DEMONSTRATING CONFLICTS ARISING FROM EACH SPOUSE'S NEED TO HAVE HIS/HER NEEDS MET BY OTHER

7 y/o states he knows Dad died, but why didn't he come to the birthday party? Defense mechanism:

DENIAL

Pt's wife states he drinks almost every night. Pt states he never drinks to excess, never drinks outside the home, never needs an eye opener, and drinking does not affect his work performance. This is an example of which defense mechanism?

DENIAL

An important counterEtransference issue in an interethnic psychotherapeutic relationship is:

DENIAL OF DIFFERENCES

Learned helplessness model for

DEPRESSION

Most common psychiatric presentation following a stroke?

DEPRESSION

Which Sxs common in pt after anabolic steroid discontinuation?

DEPRESSION

Which of the following is the most common reason for psychiatric consult referral in general medical and surgical patients?

DEPRESSION

According to the WHO, the world's greatest cause of mortality, ill health and suffering is what?

DEPRESSION AND SUICIDE

Which Sx is most common in pts with SLE?

DEPRESSION AND/OR COGNITIVE DYSFUNCTION

This is a relative contraindication for interferon treatment in pt's with Hepatitis C: (2x)

DEPRESSION WITH SUICIDAL IDEATION

According to Klein, a person who is comfortable accepting "the good with the bad" in relationships has reached which of the following positions?

DEPRESSIVE

Longitudinal studies has showed that obesity in later childhood, adol and adulthood can be predicted most commonly by presence of which psychiatric d/o in childhood and adol? (2x)

DEPRESSIVE

DSM II called Dysthymic disorder as what?

DEPRESSIVE NEUROSIS

A profound breakdown in both the logical connection between ideas and the overall sense of goalEdirectedness of speech is called:

DERAILMENT

Psychiatrist and patient move from the day room to an interview room where they have met on several occasion. The patient states, "the room looks weird and different today; it doesn't feel right." This statement is an example of:

DEREALIZATION

Starting around age 3 years, children spontaneously use language in which of the following ways?

DESCRIBE PAST EVENTS

5 y/o enacts fight between two dolls. What should therapist do?

DESCRIBE THE DOLL'S AFFECT WITHOUT ATTRIBUTING ANGER TO THE CHILD

• Descriptive diagnostic criteria • Broad definition of schizophrenia "

DESCRIPTIVE DIAGNOSTIC CRITERIA

An appropriate purpose for projective testing is to: (2x)

DETECTING THE PRESENCE OF SUBLE PSYCHOTIC THOUGHT PROCESSES

What documentation will legally protect a psychiatrist, if pt dies by suicide? (2x)

DETERMINE THE LEGAL INSANITY STANDARD TO BE USED

What is the first step when determining whether or not a criminal defendant is not guilty by reason of insanity?

DETERMINE THE LEGAL INSANITY STANDARD TO BE USED.

Pt confides to the psych MD that the pt's spouse has been physically abusing the pt. In all cases, the psych MD should do what before the pt leaves office?

DETERMINE WHETHER THE PATIENT IS IN PRESENT DANGER

Major task of a group therapy during initial engagement phase is: (2x)

DETERMINING LIMITS OF EMOTIONAL SAFETY

Pt is annoyed by family's expression of concern for his condition, saying, "what they are saying is all in the talk." What defense mechanism is this?

DEVALUING

Stockholm syndrome is defined as:

DEVELOPMENT IN HOSTAGES OF POSITIVE EMOTIONAL FEELINGS TOWARD CAPTORS

Anna Freud's contribution to child development based on conceptualizing:

DEVELOPMENTAL LINES IN 6 AREAS OF ADAPTIVE FUNCTIONING

Parents of a 16 y/o boy discover he's been visiting adult sex sites, spending up to 1hr every few wks looking at naked women and heterosexual sexual activities. Boy likes several female classmates but is shy and spends most of his time with a mixed gender group of friends. What is the explanation of his interest in these sites?

DEVELOPMENTALLY APPROPRIATE CURIOSITY

A preschooler presents to psychiatrist after being placed on psychotropic med by a PCP. Parents note that since med was started, child has shown irritability, skin picking, decreased appetite, social withdrawal, insomnia. Which med is child taking?

DEXTROAMPHETAMINE

Chronic disease causing progressive erectile failure:

DIABETES

DSM III diagnostic liability was achieved by standardizing

DIAGNOSTIC CRITERIA

Which type of therapy has individual sessions to analyze selfEdestructive cognitions/feelings/actions, and group sessions with skills training to improve relationships and decrease impulsivity?

DIALECTICAL BEHAVIORAL THERAPY

Common side effect of acetylcholinesterase inhibitors

DIARRHEA

Drug least effective as adjunctive tx of chronic violent behavior

DIAZEPAM

Due to its rate of oral absorption, what most enhances the euphoria produced by benzodiazepines with methodone?

DIAZEPAM

Which benzo accumulates with repeated administration, should be avoided in chronic renal failure, and most likely to accumulate with repeated dosing? (3x)

DIAZEPAM

Stage of group development where members testing norms, competing w/ each other, seeking autonomy

DIFFERENTIATION

25 y/o pt hospitalized for an acute psychotic break, begins to complain of thickened speech. Physical exam reveals eyes deviated to the upper right, grimacing, and posturing of the arms. The only meds taken were haldol and clonazepam. The most helpful treatment at this point would be: (3x)

DIPHENHYDRAMINE

25 y/o pt is brought to the ED with a sudden onset of severe spasms of the neck and eyes deviated up and to the right. The pt has had a viral illness with nausea and vomiting and was given prochlorperazine yesterday. Which of the following meds would be most appropriate to prescribe for this patient?

DIPHENHYDRAMINE

As result of a MVA a pt feeling panic before have to drive and has begun to avoid it. Example of mechanism of fear development:

DIRECT CONDITIONING

The most accurately describes the primary function of a mental health court:

DIRECTS MENTALLY ILL DEFENDANTS TO TX RATHER THAN PUNISHMENT

32 y/o pt with hx of schizoaffective d/o stable on clozapine is admitted to internal medicine service for a severe GI viral infection. Pt is confused, slow, appears visibly ill and tired. Pt c/o stiffness and there is some rigidity to the movements. What should be recommended?

DISCONTINUE CLOZAPINE

Psych eval requested on management of 32 y/o pt admitted by internal medicine for tx of severe gastrointestinal viral infection—dehydration, nausea, vomiting, fever. Pt has hx schizoaffective disorder, controlled w stable doses of clozapine over the past year. Staff concerned that pt might be delusional/hallucinating, as pt has appeared somewhat confused/inattentive. On exam, pt is oriented to person, place but not time. Pt somewhat slow, appears visibly ill/tired. Pt complains of stiffness, there is some rigidity to movements. Psych recommendation?

DISCONTINUE CLOZAPINE

Pt on lithium and paxil. Lithium is ineffective despite a therapeutic level. What do you do?

DISCONTINUE PAXIL

Pt receiving weekly brief psychodynamic psychotx. 2 months into tx pt acknowledges being aware of maladaptive behaviors, reports now being able to remove himself from situations that frustrate him. The pt's account is reflective of which of the following elements of brief psychodynamic psychotherapy?

DISCREPANCY

Goals of brief psychodynamic psychotherapy compared to longEterm psychodynamic psychotherapy differ how

DISCUSSION OF TRANSFERENCE IN THE LATTER

Past years annual prevalence much higher than annual incidence

DISEASE IS CHRONIC

Adopted children who have a biological parent with alcohol dependence are at increased risk of developing alcohol dependence when compared to their adoptive siblings. This is evidence for which of the following models of substance abuse?

DISEASE MODEL

Which concerns is the most common reason for referral of children and adol (6c16 y/o) to mental health professionals? (2x)

DISRUPTIVE BEHAVIOR

Which of the following diagnoses is associated with high hypnotizability potential? (2x)

DISSOCIATIVE DISORDER

Which of the following medications inhibits the enzyme ETOH acetaldehyde dehydrogenase?

DISULFIRAM

Process of gene expression

DNA TRANSCRIBED TO MRNA AND PRODUCES PROTEINS

Several months of weekly individual psychotx—woman w MDD, panic d/o describes repressed memories of sexual abuse by stepfather. Therapist neutral, explores pt's experience. Pt reports increasing conviction despite sister insisting it was impossible. Plans tp get lawyer if parents do not admit & apologize. Which is best approach?

DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION

Pt qualifies for ECT, but does not want his doc to tell him the risks. He is a "chronic worrier" and fears hearing the risks will make him anxious, perhaps to the point of refusing treatment, which he believes he needs. What is the best response?

DOCUMENT THE PT'S KNOWING AND VOLUNTARY WAIVER AND PROCEED WITH TREATMENT

Patient refusing IV antibiotics, what is a reason he would not have capacity to do this?

DOES NOT UNDERSTAND CONSEQUENCES OF REFUSING TREATMENT

During initial eval of an individual for couple's therapy, it is most critical to ask about:

DOMESTIC VIOLENCE

Females have comparable rates to males for:

DOMESTIC VIOLENCE

In addition to life support measures, which classes of medications can be considered for the treatment of neuroleptic malignant syndrome?

DOPAMINE AGONISTS

In addition to life support, which class of meds to consider for the treatment of neuroleptic malignant syndrome?

DOPAMINE AGONISTS

A crossover design is a variation of:

DOUBLEEBLIND

Type of study designs most likely to eliminate the bias of knowing what treatment is given to the pt:

DOUBLEEBLIND

Adrenogenital syndrome, Down syndrome, Hurler's syndrome, TayESachs disease and phenylketonuria all cause mental retardation. Which one does NOT have autosomal recessive inheritance pattern?

DOWN SYNDROME

Genetic syndrome considered to be a neurodevelopmental model for Alzheimer disease?

DOWN SYNDROME

What neurological syndromes is the result of trisomy 21?

DOWN SYNDROME

Which tricyclic antidepressant has the most potent antihistaminic effect?

DOXEPIN

The cognitive error of arbitrary inference is based on:

DRAWING A CONCLUSION DESPITE THE ABSENCE OF EVIDENCE OR DESPITE EVIDENCE TO THE CONTRARY

Freud's psychological theory of development (2x)

DRIVE THEORY

Most common side effect of benzos

DROWSINESS

Clinical trial: 2 study meds in 8 hospitals. 20 receive drug 1 in hospitals A,B,C,D, while 20 receive drug 2 in hospitals E,F,G,H. Drug 1 is proven and indicated treatment. Which critical confounder biases the results?

DRUG ASSIGNMENT DEPENDS ON PARTICIPANT'S HOSPITAL.

Pt arrested for posession of cocaine, spends 2 days in jail, after missing apps with subs abuse counselor. Intervention is referred to as...?

DRUG COURT

Explicit dx criteria & multiaxial system were introduced in what DSM edition? (2x)

DSMcIII

The Sural nerve biopsy of a pt w charcotEmarieEtooth type 1 is shown (image), exam shows diminished LE DTRs and deformaties of feet BL. These deformaties are typical of which molecular abnormality?

DUPLICATION OF THE PERIPHERAL MYELIN PROTEIN GENE

A patient requests an alternative tx for depression. His psychiatrist does not practice this tx himself but refers the pt to one who does. In 6mo the pt has complications from the tx and sues the 1st psychiatrist for malpractice. Which element of malpractice is missing in this case?

DUTY

At the beginning of a radio talk show a psychiatrist states he is not entering into a doctorEpatient relationship with any of the callers. Hereby he does not have _____ towards a patient in case of a malpractice suit.

DUTY

After a pt assaults a roommate on a psych inpt unit the tx team decides to have pt arrested and transferred to jail. Decision is based on ...?

DUTY TO OTHER HOSPITALIZED PTS

Antipsychotics are associated with what?

DYSTONIA, POIKILOTHERMY, LIPID SOLUBILITY, AND LOWER SEIZURE THRESHOLD

Couples therapy: what is the goal of acceptance work?

EACH PARTNER TAUGHT TO UNDERSTAND OTHER'S POSITION & RELEASE STRUGGLE TO CHANGE HIM OR HER

Genetic anticipation refers to: (2x)

EARLIER ONSET OR WORSENING OF ILLNESS WITH EACH SUCCEEDING GENERATION IN A PEDIGREE (WITH EACH TRANSMISSION OF UNSTABLE DNA)

Adolescent with a congenital physical deformity is most vulnerable to emotional disturbance during what period of development?

EARLY ADOLESCENCE (11E13 Y/O)

For adult, death of loved one by violent means affects grieving process in what way?

EARLY BEREAVEMENT IS SIMILAR, HOWEVER, DYSPHORIA PERSISTS FOR PROLONGED PERIOD

Melanie Klein differed from Freud in her emphasis on what factor?

EARLY OBJECT RELATIONS

Melanie Klein differed from Freud in her emphasis on:

EARLY OBJECT RELATIONS

Mutations in the gene that codes for the parkinson protein are most commonly associated with which parkinsonism?

EARLYEONSET PARKINSON'S DISEASE

35 y/o female failed several antidepressant trials for MDD, referred to specialty mood clinic. Clinician observes obesity, acne, and hirsuitism. What finding would increase suspicion for Cushing syndrome?

ECCHYMOSES

Pt with MDD 4Ewks into sertraline 200mg trial without improvement. Duloxetine 90mg added for an additional 6 weeks followed by 4Eweeks on phenelzine 90mg. Pt cont to be depressed. What would be the most definitive treatment:

ECT

50 y/o M hospitalized for depression and melancholia. First few therapy session should focus on:

EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT

Pt w/ schizophrenia has recently been discharged from the hospital after a first psychotic episode. FamilyEoriented therapy goals should include?

EDUCATING THE FAMILY ABOUT THE PATIENT'S ILLNESS AND PROVIDING SUPPORT FOR IMMEDIATE PROBLEMS

Which statistic measures magnitude of difference between two intervention groups?

EFFECT SIZE

A researcher wants to compare a new atypical antipsychotic medication to the already existing atypical antipsychotics. The researcher wants to conduct the study in routine clinical situations rather than using highly selected subjects. Which of the following study designs would be the most appropriate?

EFFECTIVENESS

After an OD on Amitriptyline, what test is needed? (4x)

EKG

Monitor TCA overdose using (2x)

EKG

Pt w/ hx of melancholic depression is severely dehydrated, emaciated, and catatonic. He began withdrawing, talking about death, stopped eating and drinking and lost 20lbs. Tx of choice?

ELECTROCONVULSIVE THERAPY (ECT)

Upon admission to the hospital an 85 year old man is severely emaciated, dehydrated, and catatonic, and has lost 20 lbs. He has a 35Eyear history of melancholic depression. 4 weeks ago he began withdrawing from relatives, talking constantly talking about death and stopped eating or drinking unless prompted by his daughter insistently. Prior to exhibiting these symptoms the patient was medically stable and reportedly healthy. What is the appropriate therapy once the patient is medically stabilized?

ELECTROCONVULSIVE THERAPY (ECT)

Which ages of children are interested in secrets, collecting, and participating in organized games? (2x)

ELEMENTARY SCHOOL

An important technique or goal of cognitive therapy is?

ELICITING AND TESTING AUTOMATIC THOUGHTS

The purpose of designing a study to use the doubleEblind method is to:

ELIMINATE BIAS DUE TO EXAMINER EXPECTATIONS

The purpose of designing study to use the double blind method is to:

ELIMINATE BIAS DUE TO EXAMINER EXPECTATIONS

The approach to diagnosis that has been taken in current editions of the DSM is considered to grow from and be closest to that of whom?

EMIL KRAEPELIN

Who noted that major mental illnesses have different courses and outcomes; And also differentiated between dementia praecox and maniccdepressive illness? (5x)

EMIL KRAEPELIN

Secure attachment in an infant is associated with which of the following outcomes?

EMOTIONAL AND SOCIAL COMPETENCE

Homicide and homicidal behaviors are most often related to what factors?

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS

Homicide and homicidal behaviors are most often related to which of the following factors?

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS.

In psychotherapy a pt states that he still feels devalued by criticism of father. Therapist comment: It must hurt when you are treated that way. This is example of:

EMPATHIC VALIDATION

Therapy intervention most frequently assoc w Kohut's selfEpsychology:

EMPATHIC VALIDATION

A pt with h/o lifelong depression & failed relationships complains (very angry) (after several weeks of therapy) that she is expected to trust the Dr. without even knowing anything about him (credentials or personally) what should the Dr say?

EMPATHIZE WITH THE PT'S FEARS OF TRUST AND FEELING OF BEING AT A DISADVANTAGE

The best response to a pt who reports a fixed false belief that his neighbor is poisoning his dog and sitting all day at the window monitoring is: (2X)

EMPATHIZE WITH THE PT, BUT AVOID DIRECT CONFRONTATION ABOUT THE DELUSION

Two most powerful predictors of outcome in any form of psychotherapy are: (2x)

EMPATHY AND THERAPEUTIC ALLIANCE

14 y/o brought to ED after telling mom that she had been raped by stepdad. On psych eval, pt reports feeling "okay" and denies acute distress. Pt is calm during interview and appears generally unaffected by recent trauma. On further questioning, pt appears confused and believes she is at a friend's house. Which is the preferable intervention?

EMPLOY GROUNDING STRATEGIES TO ORIENT PT

81. According to Winnicott's theory of the development of an infant's assertiveness and sense of competence what best describes the critical function of the holding environment?

ENCOURAGES SPONTANEITY WHILE PROTECTING THE CHILD FROM HARM

Which of the following hypnotic techniques is used for most pts?

ENCOURAGING THE PT TO USE INNER RESOURCES FOR ADAPTIVE COPING STRATEGIES

Therapist validates family's strengths/resources in dealing w pt's schizophrenia at biE weekly family meeting. What stage of family psychoeducational model is this?

ENGAGEMENT

Which of the following parent behavior is most important to toddlers language development?

ENGAGING IN FREQUENT CONVERSATION AND THINKING ALOUD

What is the underlying mechanism of action of sildenafil in erectile dysfunction?

ENHANCEMENT OF NITRIC OXIDE

11 y/o boy has frequent episodes of ulcerative colitis requiring frequent hospitalization. While in the hospital, mother never leaves his side and responds to questions for him, often referring to disease as "our disease." According to Minuchin's theory of family interactions, this is: (3x)

ENMESHED

Small pilot study measures changes in MMSE scores to compare the efficacy of two meds for the treatment of Alzheimer's. Data says there's difference between meds, but not statistically significant. What do you need to do to clarify?

ENROLL MORE SUBJECTS TO OBTAIN A LARGER SAMPLE SIZE

15 y/o pt depressed + suicidal has an alcoholic father. Prior d/c from hospital the next step should be:

ENSURE THAT ANY LETHAL MEANS ARE UNAVAILABLE AT HOME

According to NIMH Epidemiologic Catchment Area Program's reports on ethnicity & prevention of mental disorders, the lifetime rates of APD are: (5x)

EQUAL AMONG ASIANS, HISPANICS, AFRICANc AMERICANS, AND WHITES.

Which of the following probabilities most accurately describes the likelihood of patients with schizophrenia committing homicide compared with the general population?

EQUAL LIKELIHOOD

Who established that learning produces changes at the neuronal level, in turn facilitated by alterations in gene expression:

ERIC KANDEL

Which individual articulated a theory of psychosocial developmental phases according to a predetermined sequence?

ERIK ERIKSON

15 y/o pt w/ physical complaints, decreased appetite, irritability, thoughts of death, anhedonia. Which med is FDAcapproved for first line tx? (2x)

ESCITALOPRAM

Most prevalent movement d/o in those over 70 y/o?

ESSENTIAL TREMOR

Pt consults psychiatrist b/c former psychiatrist has retired & pt wishes to continue Tx w antidepressants. The pt is seeing a counselor for weekly psychotherapy and plans to continue. The psychiatrists eval confirms the Dx of MDD and psychiatrist feels that continuing the pt 's antidepressant is indicated. Next step? (2x)

ESTABLISH A CLEAR UNDERSTANDING OF THE DIVISION OF RESPONSIBILITIES BETWEEN PSYCHIATRIST AND COUNSELOR

What is the first priority in ER management of a rape victim?

ESTABLISHING PSYCHOLOGICAL SAFETY

Power analysis is a statistical method used to:

ESTIMATE THE SAMPLE SIZE REQUIRED TO DETECT STATISTICAL EFFECT OF A DEFINED SIZE FOR TWO OR MORE PREDICTORS.

Psych MD wishes to charge pts for appointments that they do not keep. According to code of ethics of APA, such a policy is:

ETHICAL IF PT IS SPECIFIC NOTIFIED IN ADVANCE

Psychiatrist wishes to charge pts for appointments that they do not keep. According to code of ethics of the American psychiatric association such a policy is:

ETHICAL IF THE PATIENT IS SPECIFICALLY NOTIFIED IN ADVANCE

A psychiatrist wishes to charge patients for appointments that they do not keep. According to the code of ethics of the APA, such policy is:

ETHICAL IF THE PT IS SPECIFICALLY NOTIFIED IN ADVANCE

Common ancestry + a shared sense of identity, beliefs, and history

ETHNICITY

Which demographics indicate both a common ancestry and a shared sense of identity, belief and history?

ETHNICITY (NOT RELIGION)

Which individual coined the term "schizophrenia" and introduced the terms "ambivalence" and "autism"? (3x)

EUGENE BLEULER

62 y/o with lung cancer, weight loss, fatigue, and persistent cough. Pat refuses to accept Dx of cancer and states will "get over this infection." Pt refuses all further testing and asks for antibiotics to "recover in peace." C&L psychiatrist's role is:

EVALUATE PT'S COPING STYLE AND HELP THE MEDICAL TEAM SEE THE PT'S RESPONSES IN THE CONTEXT OF HER UNIQUE PERSONALITY AND LIFE CIRCUMSTANCES

In "split treatment," the role of the prescribing psychiatrist is to:

EVALUATE PT'S NEED FOR MED & PRESCRIBE ACCORDINGLY WHILE MAINTAINING REGULAR CONTACT W THERAPIST.

14y/o from juvenile hall, getting aggressive. Long h/o behavior problems but no psych or medical hx. In addition to diagnosing behavior problem, what is first step for psychiatrist? (2x)

EVALUATE THE PATIENT FOR ADDITIONAL PSYCHOPATHOLOGY

Pt getting psych exam to determine suitability for a job must be informed:

EXAM IS NOT CONFIDENTIAL

Pt receiving a psychiatric examination to determine suitability for a job must be informed that:

EXAMINATION IS NOT CONFIDENTIAL

Psychiatrist's mind wanders during sessions, what should the psychiatrist do?

EXAMINE INNER THOUGHTS AND FEELINGS

Midway through psychotherapy session, a psychiatrist's mind wanders despite repeated refocus. Best immediate action:

EXAMINE OWN INNER FEELINGS ABOUT THE PATIENT

40 y/o M developed gradually progressive dementia and abnormal involuntary movements. Older brother and father have similar illness. Best Dx. test (2x)

EXCESS CAG TRIPLETS IN DNA ANALYSIS

Psych MD tests a medical pt with go/noEgo test in which psych MD asks pt to tap the table once if Psych MD taps it once, but not to tap the table if psych MD taps it twice. Psych MD is screening for deficits in?

EXECUTIVE FUNCTIONING

A child's understanding of death, attitudes, and responses at a preoperational stage of cognitive development include:

EXPECTING THE DEAD RELATIVE TO WAKE UP

2 y/o M has been preoccupied with a small blanket for several months, carries it w/ him everywhere and becomes upset if anyone tries to take it away. He refused to stay w/ a babyEsitter until it was retrieved. The psychiatrist should:

EXPLAIN THIS IS NORMAL AND CHILD WILL EVENTUALLY GIVE IT UP ON HIS OWN.

6 y/o w/ 4 wk intense eyeEblinking and lip pursing. Wax and wane, increase with stress. Family Hx of tic d/o. First step:

EXPLAIN TO FAMILY MAY BE TRANSIENT

Young female starting cognitive therapy with a female resident asks for a hug. Resident should first

EXPLAIN WHY PHYSICAL CONTACT IS AVOIDED

C&L psychiatrist uses all therapeutic approaches except:

EXPLORATORY PSYCHODYNAMIC

Pt recurrently goes to ED because of severe chest pain. Has been w/u for everything and all test are normal. He states that something needs to be done to "fix" his pain. Psych consult is placed. MSE and neuro is normal. Past hx reveals his father died of lung CA. Next intervention as psychiatrist is:

EXPLORE PT'S FEELINGS ABOUT FATHER'S DEATH

Psychiatrist is treating an older pt who is a successful executive. Pt feels grateful for the help w/ his depression and offers some tips on investing to the psychiatrist. What is the most appropriate action at this point from the psychiatrist?

EXPLORE PT'S MEANINGS AND FEELINGS ABOUT THE OFFER

9 yo f bibEparents for outpt evaluation due to behavior difficulties at home. Port daughter "explodes" when she doesn't get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states "sometimes I just get mad." At a follow up interview the physician learns the outbursts are related to parental disputes. What is the next treatment step?

EXPLORE REASONS FOR PARENTAL DIFFERENCES

The parents of a toddler are concerned about a rent increase in the frequency, intensity and duration of the child's temper tantrums. The parents report that the toddler gets on the floor, kicks and screams when they set limits. The child's health and developmental history is unremarkable. FMHx significant for mood disorders and ADHD and ODD. Which of the following would be most appropriate as next step?

EXPLORE THE PARENTS' CONCERNS ABOUT SEEMINGLY NORMAL BEHAVIOR

36 y/o pt is beginning psychodynamic psychotherapy for tx of longE standing problems of inability to establish satisfying ongoing relationships. Pt expresses much skepticism that "talking about my past" will help. The most appropriate response of therapist is:

EXPLORE THE PROCESS DURING THE SESSION THAT MIGHT BE INTERFERING WITH THE ESTABLISHMENT OF THE THERAPPEUTIC ALLIANCE

Which psychotherapeutic technique is most clearly indicated for treatment of simple phobia?

EXPOSURE THERAPY

3 y/o not speaking intelligibly. Normal hearing. Parents worried about autism.

EXPRESS SOME CONCERN TO PARENTS

The parents of a 3 y/o child are concerned because she has not begun speak intelligently. The child's hearing is normal. Doctor's response:

EXPRESS SOME CONCERNS BC MOST CHILDREN THIS AGE CAN EFFECTIVELY MAKE THEMSELVES UNDERSTOOD.

The validity of an assessment instrument refers to:

EXTENT TO WHICH IT MEASURES WHAT IT INTENDS TO MEASURE.

Judgment by experts that items on a test "makes sense" is an example

FACE VALIDITY

Which of the following instruments would be most appropriate to measure the intensity of pain in young children?

FACES SCALE

Psychiatrist behavior of raising eyebrows, leaning towards pt, saying "UhEhuh"

FACILITATION

"When you mentioned your sibling's problem, your voice cracked and, for a moment, I thought I heard anger in your voice." Which interviewing technique does psychiatrist use here?

FACILITATION, REFLECTION

A psychiatrist whose pt is involved in a workErelated lawsuit receives a subpoena to produce the pts records of psychiatric treatment and to testify about the treatment is a court of law. Upon speaking with the attorney who issued the subpoena and who era resent the opposing party, the psychiatrist is told "you will not be asked to render an independent opinion related to legal questions." Which best describes the psychiatrist's role.

FACT WITNESS

What best characterizes the current explanation for group differences in prevalence of psychiatric illness?

FACTORS THAT PROMOTE VULNERABILITY TO STRESS

Example of learned helplessness is a child who stops all attempts to improve after being punished for failing or failing no matter how hard the child tries? (2x)

FAILING NO MATTER HOW HARD THE CHILD TRIES.

Best indication for residential treatment of substance abuse? (3x)

FAILURE TO MAINTAIN ABSTINENCE AFTER TREATMENT IN INPATIENT SETTINGS

Sufficient to establish that a person is incompetent to stand trial (3x)

FAILURE TO UNDERSTAND THE CHARGES ONE IS FACING

Preschool children with imaginary friends are:

FAIRLY NORMAL

Which of the following approaches is likely to obtain the most accurate information on the factors influencing a family's level of functioning

FAMILY COPING STRATEGIES IN RESPONSE TO PAST STRESSORS

What type of group therapy is based on the unit functioning to maintain its own homeostasis of interacting?

FAMILY GROUP THERAPY

family psychoeducation programs for psychotic disorders reduce symptom severity and relapse risk by reversing what?

FAMILY MEMBERS EXPRESS CRITICISM, HOSTILITY AND BLAME TOWARDS THE PATIENT

Which psychosocial therapies for pts w/ schizophrenia has been showed to reduce relapse rates? (3x)

FAMILY PSYCHOEDUCATIONAL THERAPY

Pts taking MAOIs should use caution when consuming what?

FAVA BEANS

Most distinguishable aspect of childhood separation anxiety d/o when compared to other childhood anxiety disorders (2x)

FEAR THAT SOMETHING BAD WILL HAPPEN TO THEM OR THEIR PRIMARY CARETAKER

Erikson theorized that a successful developmental task in the 40c60 y/o group is to? (2x)

FEEL USEFUL TO SOCIETY THROUGH BEHAVIORS THAT PROTECT FUTURE GENERATIONS

Erikson theorized that a successful developmental task in the 40E60 y/o group is to:

FEEL USEFUL TO SOCIETY THROUGH BEHAVIORS THAT PROTECT FUTURE GENERATIONS.

When asked to describe why a sameEage, sameEsex peer is a "best friend," an 11E yearEold child is most likely to cite which of the following as most important?

FEELING CARED ABOUT BY THE OTHER CHILD

Sign of pyromania

FEELING RELIEF ON SETTING A FIRE

From cognitiveEbehavioral perspective, which is most responsible for major depression?

FEELINGS OF DEVALUATION

Masturbation with a vibrator is used for treatment of which sexual dysfunction?

FEMALE ORGASMIC DISORDER

Which med is comparative safety during Tx w/ MAOI?

FENTANYL

The nonEgenetic cause of mental retardation in the US is:

FETAL ALCOHOL SYNDROME

Recurrent, intense sexually arousing fantasies, urges, or behaviors including the use of nonliving objects are main dx feature of what d/o

FETISHISM

Recurrent, intense sexually arousing fantasies, urges, or behaviors, including the use of nonliving objects, are the main diagnostic feature of which disorder?

FETISHISM

These symptoms make a diagnosis of NMS more likely than other neurological and general medical conditions:

FEVER AND SEVERE MUSCLE RIGIDITY

The ability of magnetic seizure therapy to target specific brain regions implicated in depression gives it what potential advantage, compared with traditional ECT:

FEWER COGNITIVE SIDE EFFECTS

A pt suffers as a result of the pt's psychiatrist going on vacation w/o providing coverage. The psychiatrist's problematic behavior violates which of the following ethical principles?

FIDELITY

A psych consultation is requested for a patient whom the medical team believes is manufacturing symptoms of an illness. Which of the following factors would be most consistent with a diagnosis of malingering?

FINANCIAL INCENTIVE FOR ILLNESS

A risk factor for child abuse:

FINANCIAL STRESS

Parents of child with ADHD and ODD. They want to know psychotherapeutic approaches how to proceed with kid

FIND OUT WHAT KIDDO LIKES AND MAKE A BEHAVIOR REWARD PROGRAM FOR YOUR CHILD AT HOME AND SCHOOL

What is type II error?

FINDING ANTIDEPRESSANT INEFFECTIVE WHEN IT IS ACTUALLY EFFECTIVE

Which of the following is predictive of better adaptation in bereavement?

FINDING MEANING IN LOSS

Pt is engaged in interpersonal psychotherapy for depression. In the first several sessions, the patient and therapist identify unresolved grief after the death of the patient's mother as the problem area, and relate these feelings to the patient's current depression. Which of the following will be the focus of the middle phase of treatment?

FINDING NEW ACTIVITIES AND RELATIONSHIPS TO OFFSET THE PATIENT'S LOSS

Most common method for completed suicides in adolescents (2x)

FIREARMS

Most common method of committing suicide for women in the US is:

FIREARMS

Which of the following is the most common method of completed suicide in female children and adolescents?

FIREARMS

Reinforcing behavior w reward every third time a behavior is done is called:

FIXED RATIO

10 y/o child learned to clean his room without being asked. The parents achieved this by reinforcing this behavior with a onecdollar bill every third time the child cleaned the room without being asked. This type of reinforcement schedule is known as: (4x)

FIXED-RATIO

Pt with multiple social fears is terrified of public speaking. As the next step in treatment, the therapist arranges for the pt to give 15 minutes talk to clinical staff. This is an example of:

FLOODING

Take agoraphobic to crowded place and stay there until anxiety dissipates

FLOODING

Which of the following reverses the effects of benzodiazepines?

FLUMAZENIL

Intake of this increases lithium levels

FLUOXETINE

Pt who responded in the past to SSRIs requests a drug from this class when subsequently seen for another episode of depression. However, pt reports concerns that when the previous medication was tapered, pt experienced fatigue, insomnia, abdominal distress, fluElike symptoms, and dizziness. What meds would be appropriate for this pt?

FLUOXETINE

This SSRI is used to treat the discontinuation syndrome caused by termination of other SSRI's:

FLUOXETINE

Tx of premature ejaculation (MEN) and premenstrual dysphoric d/o (WOMEN): (3x)

FLUOXETINE

What med has some evidence of effectiveness in both psychotic/nonpsychotic subtypes of body dysmorphic disorder?

FLUOXETINE

Which of the following SSRIs has longest halfElife?

FLUOXETINE

Which of the following meds has the lowest likelihood of discontinuation symptoms if the medication is abruptly stopped?

FLUOXETINE

Cytochrome P450 (CYP450) subenzyme, inhibited by ______, increases TCA levels ____

FLUOXETINE, 2D6

Longest halfElife amongst alprazolam, flurazepam, lorazepam, temazepam and triazolam

FLURAZEPAM (DALMANE) USED FOR INSOMNIA

Dermatologist asks for psych consult on 38 y/o pt. 5 years ago pt began having concerns of perceived skin irregularity she calls "bumps." Over time increasingly more difficult for her to ignore "bumps" and picks at them. Several dermatologists have been unable to convince pt it is not a dermatological issue. Aside from this no evidence of other mood or thought d/o. FirstEline treatment for pt?

FLUVOXAMINE

SSRI with shortest half life

FLUVOXAMINE

46 y/o F pt presents w increasing dysphoria, progressively increased frequency with which she washes her hands to the point of excoriation, dose range for effective Tx:

FLUVOXAMINE 200E300MG DAILY

When conducting marital therapy with a couple who begin to talk about divorce, what should the psychiatrist's stance be? (2x)

FOCUS ON THE COUPLE'S RESPONSIBILITY TO DECIDE THE FUTURE OF THEIR RELATIONSHIP

Empirical studies of the diagnostic psychiatric interview process have suggested that the most comprehensive and accurate information is elicited by which of the following approaches?

FOCUSED INTERVIEWING, ELICITING DETAILS OF THE CHIEF COMPLAINT AND THEN AN INVENTORY OF SYMPTOMS

Treatment with this can mask B12 deficiency by normalizing macrocytic anemia

FOLIC ACID

Essential element of wraparound treatment

FORMAL MENTAL HEALTH SERVICES AND INFORMAL COMMUNITY SUPPORT

Most common inherited mental retardation:

FRAGILE X

13 y/o w developmental delay, stereotyped behaviors, impaired social interactions, hyperactive behavior, large anteverted ears, hyperextensible joints, macroorchidism. Dx? (3x)

FRAGILE X SYNDROME

Replaced use of hypnosis by Freud:

FREE ASSOCIATION

91 y/o hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)

FREQUENT SMALL SIPS OF WATER

25 y/o M pt has noted sexual arousal and even attained erections while rubbing up against unsuspecting women on subway. (2x)

FROTTEURISM

Male physician repeatedly accused by adult female pts of sitting opposite them on his stool during eye exam, opposing knees alternating, in such a manner that one of pts' knees touches physician's crotch. If true, this is an example of

FROTTEURISM

Optimal strategy in maintenance tx with TCA for patient with recurrent MDD (2x)

FULL DOSE ANTIDEPRESSANT THERAPY

Which of the following statements best describes the current conceptualization of family that informs family system theories and treatment approaches?

FUNCTIONING FAMILIES TEND TO HAVE CERTAIN SHARED CHARACTERISTIC ATTRIBUTES RATHER THAN COMMON STRUCTURES

A compound that increases muscle mass by increasing episodic secretion of GH:

GAMMA HYDROXYLBUTYRATE

Pt tells doctor: "I feel like a woman trapped in man's body." Most likely dx:

GENDER IDENTITY DISORDER

Assessment instrument used in epidemiology study relies solely on subjects report:

GENERAL HEALTH QUESTIONAIRE

Erikson's psychosocial stage in which a person invest energy into establishing, caring for, and guiding in the next generation? (2x)

GENERATIVITY VS STAGNATION

Which is a common side effect leading to discontinuation of SSRI's early in treatment?

GI DISTRESS

Most of the body's serotonin is located where?

GI TRACT

What substance is associated with a risk of bleeding when taken with antiEplatelet drugs or warfarin?

GINGKO BILOBA

20 y/o pt w/cancer pain is on a methadone maintenance program. Staff feels request for additional narcotics represent drugEseeking behavior. Recommendation?

GIVE PT MORE OPIOID MED TO ACHIEVE ADEQUATE PAIN CONTROL B/C OF PT'S TOLERANCE

Awareness of own symptoms rated by:

GLOBAL ASSESSMENT SCALE

Pharmacokinetic factor that declines w/ aging?

GLOMERULAR FILTRATION RATE

Which characteristics of selfEhelp groups distinguishes them from traditional psychotherapy groups?

GOALS/OBJECTIVES DON'T ADDRESS INTRAGROUP DYNAMICS

In combo w growth hormone (GH), what is required to initiate adolescent growth spurt?

GONADAL HORMONES

5 y/o boy becomes restless, impulsive, and difficult to manage when not given sufficient exercise. Teacher gives him increased motor activity, and his behavior improves. This is an example of: (2x)

GOODNESS OF FIT

68 y/o pt w/ hx of schizophrenia since early adulthood and maintained for yrs on thioridazine. On exam: pt's tongue frequently retracts on its longitudinal axis and moves in lateral directions. No other findings. When tongue movements are pointed out, pt reports being unaware of making them. What recommendation for best Tx:

GRADUALLY D/C THIORIDAZINE AND START LOW DOSE RISPERIDONE

Cognitive strategy of typically developing schoolEage children in response to their environment?

GRADUALLY INTEGRATING THESE NEW EXPERIENCES INTO PREEEXISTING MENTAL CONSTRUCTS

Therapeutic empathy is best described as the therapist's ability to: (2x)

GRASP PT'S INNER EXPERIENCE FROM PT'S PERSPECTIVE

How is ethnicity defined? (2x)

GROUP OF INDIVIDUALS SHARING SENSE OF COMMON IDENTITY, COMMON ANCESTRY, SHARED BELIEFS, & HX

Tendency for groups to arrive at more extreme decisions than for individual group members alone

GROUP POLARIZATION

Pt with schizoid personality disorder has elaborate fantasy relationships but has no real friends. Most helpful therapy to assist pt in forming satisfying interpersonal relationships?

GROUP THERAPY

50 y/o Cambodian woman with 2 kids suffered catastrophic trauma from the Pol Pot regime in Cambodia (rape, abuse, watched family starve, escaped refugee camp with 2 kids). Has PTSD/MDD sx that are increased when her now grown daughter dates man patient doesn't like. Needs supportive therapy, antidepressant, AND?

GROUP THERAPY OF PEOPLE OF THE PATIENT'S OWN BACKGROUND WHO SHARE THE SAME EXPERIENCE

Psychosocial therapy that has shown efficacy in some studies in improver cancer survival rates:

GROUP THERAPY WITH OTHER CANCER PATIENTS

The side effects of sedation and weight gain are associated with mirtazapine's antagonism of which of the following receptors?

H1

CBT for pts with OCD involves gradually exposing the pt to a feared stimulus and preventing the ritualized response. Over time, this results in decreased anxiety to the stimulus demonstrating which of the followingAn important technique or goal of cognitive therapy is:

HABITUATION ELICITING AND TESTING AUTOMATIC THOUGHTS

A child with temper tantrums at home begins to have better control over her outbursts following which intervention by parents?

HAD NEGATIVE REINFORCEMENT OF THE TANTRUMS REMOVED

A safe med for the fetus of pregnant woman during agitation of a manic episode:

HALDOL

28 y/o woman who is at 33 weeks gestation and has a history of bipolar disorder is brought to the emergency department by family members because she was running around the neighborhood loudly proclaiming, "I am the mother of Christ." The pt is in restraints, yelling, spitting, disorganized, and tangential, with rapid speech. Family members report that the pt was stable on valproate, but discontinued the medication when she learned she was pregnant. Which medication to give acutely for this pt?

HALOPERIDOL

What psychological test determines neuropsychologic impairment? (2x)

HALSTEADcREITAN BATTERY

The four basic elements that must be proven in order to sustain a claim of malpractice against a physician include a duty of care owed to the patient, negligence, causation, and what?

HARM TO THE PATIENT

Who coined the term "contact comfort" and demonstrated that newborn Rhesus monkeys separated from their mothers chose contact comfort over food and water?

HARRY HARLOW

Developed interpersonal theory of psychiatry

HARRY STACK SULLIVAN

Which of the following is characteristic of both interpersonal psychotherapy, CBT?

HAS A HERE AND NOW FOCUS

25 y/o M scores in MMPI are all normal except for elevated scores on the depression and psychasthenia scales. This suggests:

HAS DEPRESSION WITH ANXIETY AND OTHER NEUROTIC SYMPTOMS

Lithium can be removed via hemodialysis because? (2x)

HAS NO METABOLITES

Exposure and flooding together with response prevention are techniques of behavioral therapy aimed at which of the following?

HASTENING THE EXTINCTION OF A CONDITIONED FEAR OR ANXIETY RESPONSE

According to classical conditioning, what would best unpair the conditioned stimulus from the unconditioned stimulus for a patient who first got drunk when a certain song played on the radio and now has cravings whenever he hears that song?

HAVE PATIENT REPEATEDLY LISTEN TO THE SONG IN THE ABSENCE OF ALCOHOL

The culturally and Linguistically Appropriate Services (CLAS) federal standards for healthcare organizations require the organizations to:

HAVE PTERELATED MATERIALS AVAILABLE IN THE PT'S NATIVE LANGUAGES.

A father wants to know if he should allow his 5 y/o child to attend the funeral of her mother. The child expresses a desire to go. To help the child through the funeral, it will be important to do which of the following?

HAVE SOMEONE FAMILIAR ACCOMPANY THE CHILD

Most powerful statistical risk factor for completed and attempted suicide

HAVING A PSYCH ILLNESS

Highest rate of suicide associated with

HAVING READY ACCESS TO FIREARMS

Resilient individuals who do well in developmental course through life despite being at high risk for negative outcomes are thought to be protected in adulthood most by:

HAVING THE ABILITY TO FIND, USE AND INTERNALIZE SOCIAL SUPPORTS

Serum Li levels can increase significantly when given w which HTN med? (3x)

HCTZ

A suicidal 18 y/o pt who lives with his parents is evaluated in the ED. The psychiatrist warns the pt that if he does not sign in voluntarily for inpt tx, the psychiatrist will involuntarily hospitalize the pt. The pt consents to inpt care. The pt in this situation has not given valid informed consent because:

HE WAS COERCED INTO GIVING CONSENT

Which of the following is the leading cause of child maltreatment fatalities?

HEAD INJURIES

Lithium exposure in first trimester of pregnancy increases risk of congenital abnormalities in which organ? (2x)

HEART

The difference between an idea of reference and a delusion of reference is that the former is:

HELD WITH LESS CONVICTION

25 y/o F is brought to ER after being severely beaten by her BF. Following medical stabilization, first step in an acute psychological intervention is:

HELP HER RECOGNIZE THAT IMMEDIATE DANGER HAS PASSED AND SHE IS IN A SAFE PALCE

Most appropriate rationale for using humor in CBT

HELPING TO CREATE A NEW PERSPECTIVE ON OTHERWISE DISTORTED COGNITIONS

Treatment of choice for lithium intoxication who manifests impaired consciousness, neuromuscular irritability, and seizures is (10x)

HEMODIALYSIS

Most frequent route for HIV transmission in teenage girls

HETEROSEXUAL CONTACT

Psych MD is counseling a pt about risks and benefits of ECT. What statement correctly describes the risk of cognitive impairment?

HIGH DOSE UNILATERAL ELECTRODE REPLACEMENT IS ASSOCIATED WITH LESS COGNITIVE IMPAIRMENT.

In patients on lithium, what type of thyroid dysfunction can occur?

HIGH PREVALENCE OF THE PRODUCTION OF THYROID AUTOANTIBODIES

A test that detects 98% of the people who have a disease, but also provides a false positive result for many of the people without the disease, would have a:

HIGH SENSITIVITY AND LOW SPECIFICITY

Test detects 98% of people w/ disease, but also high false positive rate

HIGH SENSITIVITY, LOW SPECIFICITY

Compared to those described as "low reactive" in Kagan's longitudinal study of childhood inhibition, children described as "high reactive" at age 4 months were characterized by:

HIGHER RATES OF SOCIAL ANXIETY AT AGE 13

Who characterized mental illness based upon the interaction of the four humors? (2x)

HIPPOCRATES

Psychiatrist evaluates recent immigrant with complaint of "altered nerves" Clinical interpreter from pt's cultural background explains that culturally the nervous system is believed to be altered by stressful life events. What cultural group does pt most likely belong to?

HISPANIC AMERICAN

Mirtazapine's side effects of sedation and weight gain are caused by binding to which receptors?

HISTAMINE

Predictor of positive response to lithium prophylaxis

HISTORY OF GOOD INTEREEPISODE FUNCTION

Based upon longitudinal studies, which risk factors correlated w/ suicide more than one year after initial assessment?

HISTORY OF PRIOR ATTEMPTS AND HOPELESSNESS

Which of the following factors carries the highest standardized mortality ration for suicide

HISTORY OF PRIOR SUICIDE ATTEMPTS

A 40EyearEold pt is hospitalized for eval of fever, weight loss and ataxia. Psychiatric consultation is requested as the patient seems depressed, and a family member reports that the pt has been exhibiting progressive memory loss over the last several months. Which of the following lab tests may help explain the patient's presentation?

HIV

34 y/o pt w/ hx of memory impairment dies of unknown cause for autopsy. Pathological exam: diffuse and multifocal rarefaction of cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Most likely Dx:

HIVEASSOCIATED DEMENTIA

Which is seen in 90 - 100% of pt w/ narcolepsy (genetics)

HLAEDR2

Leading cause of death for 15E24 y/o African American males?

HOMICIDE

In the cognitive therapy model, which of the following is most associated with suicide risk?

HOPELESSNESS

Which of the following factors is most closely associated with child abuse and neglect?

HOUSEHOLD POVERTY

Piaget interested in:

HOW A CHILD ARRIVES AT ANSWERS

Piaget's contribution to development was a theory explaining what phenomenon? (2x)

HOW INDIVIDUALS LEARN AND UNDERSTAND THE WORLD

In the context of the psychodynamic psychotherapy, the term "frame" refers to which of the following aspects of therapy?

HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES

In context of psychodynamic psychotx, "frame" refers to what aspect of therapy?

HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES.

In Vaillant's model of life span development, what is classified as a mature defense mechanism:

HUMOR

Appropriate management of neuroleptic malignant syndrome:

HYDRATION AND COOLING

Which of the following would represent a concern if administered concomitantly with a SSRI?

HYPERICUM PERFORATUM

What has demonstrated efficacy for IBS? (4x)

HYPNOSIS

Absorption, dissociation, and suggestibility converge during:

HYPNOTIC CONCENTRATION

Ability to get so caught up in an experience that one loses awareness of surroundings

HYPNOTIZABILITY

What statements regarding hypnosis is correct

HYPNOTIZABILITY IS A MEASURABLE TRAIT

Exogenous testosterone may be useful in treating what male sexual disorder?

HYPOACTIVE SEXUAL DESIRE

What somatoform d/o has male=female?

HYPOCHONDRIASIS

Dysfunction of which is specifically implicated in the pathophysiology of narcolepsy?

HYPOCRETIN

Cardiac effects of lithium resemble what on EKG

HYPOKALEMIA (LOW T WAVES)

Most frequent side effect of MAOI's

HYPOTENSION

Interferes w/ clearance of lithium

IBUPROFEN

"When I hear the news, the newscaster is talking about me." This represents?

IDEAS OF REFERENCE

Father is dying. Pt is not a drinker, but went from bar to bar drinking dad's favorite drink. Bars are similar to those dad used to go to. Best interpretation of this behavior:

IDENTIFICATION WITH OR INCORPORATION OF PATIENT'S FATHER

Freud says depression is anger turned inward against self due to:

IDENTIFICATION WITH THE LOST OBEJECT

MMPI does what? (2x)

IDENTIFIES MAJOR AREAS OF PSYCHOPATHOLOGIC FUNCTIONING

Specificity is:

IDENTIFYING THE # OF PT WITHOUT THE CONDITION WHO HAVE A NEG TEST RESULT

Freud says that boys resolve oedipal complex by:

IDENTIFYING WITH FATHERS

A 23 yo pt began psychotherapy due to feelings of inadequacy and depression in the context of working in a coffee shop since graduating from college and deferring medical school acceptance. The pt has been having conflicts with parents over his ambivalence in becoming a physician. Which of the following is the most likely developmental task with which the pt is struggling?

IDENTITY

It is ethical for a psychiatrist to bill pt for a missed appointment if:

IF PAYMENT FOR MISSED APPT FALLS IN CONTRACTUAL AGREEMENT.

23 y/o admitted in inpatient unit w/ Dx acute psychotic d/o after threatening to beat up his mother (with whom he lives). Agreed to voluntary admit, but 2 days later demands to sign out AMA. What justifies involuntary hospitalization in this pt? (2x)

IF THE PATIENT CONTINUES TO THREATEN HIS MOTHER

Pt w fear of heights. Pt instructed to visualize crossing a bridge. What is the therapeutic technique?

IMAGINAL EXPOSURE

What determines disability?

IMPAIRMENT AFFECTS ABILITY TO MEET PERSONAL, SOCIAL, OR OCCUPATIONAL NEEDS

Psychoeducation provided after the first hospitalization of new diagnosed schizophrenia would include teaching the family, patient what?

IMPORTANCE OF TAKING MEDS

Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Which learning principle? (2x)

IMPRINTING

Goal of CBT for chronic pain tx is

IMPROVE FUNCTIONING DESPITE PAIN

An effective consultationEliaison psychiatry program in a medical hospital will result in which of the following?

IMPROVED TREATMENT COMPLIANCE

Which best defines goals of supportive psychotherapy?

IMPROVEMENT OF REALITY TESTING AND REESTABLISHMENT OF THE USUAL LEVEL OF FUNCTIONING

What represents major goal of psychotherapy as conceptualized by selfEpsychology?

IMPROVING THE ABILITY TO USE THE APPROPRIATE AFFIRMING RESPONSES FROM OTHERS

An association has been reported in adol with BPD between serotonin dysregulation, suicidal behavior, aggression and ... (2x)

IMPULSIVITY

Terminally ill cancer patients who experience concerns about a "bad death" are most typically worried about dying how?

IN PAIN

Rapid eye movement (REM) sleep is first evidenced at which stage of development?

IN UTERO

Family of 75 y/o pt is concerned about his safety b/c he has been forgetting to turn off stove. Psych MD suspects an evolving cognitive d/o. What is most likely to be the earliest impairment to occur in the pt?

INABILITY TO RECALL 3 WORDS AFTER A 3 MIN DELAY

Disharmony between feeling tone and speech content

INAPPROPRIATE

A caseEcontrol study can appropriately answer an epidemiological question when the:

INCIDENCE OF DISEASE IS LOW

A caseEcontrol study would be appropriate in answering an epidemiological question when the:

INCIDENCE OF THE DISEASE IS LOW

Recommended procedure for patient handoff between residents?

INCLUDES SUMMARY OF TREATMENT COURSE AND RISK ASSESSMENT

According to operant conditioning, behavior decreases in frequency if (4x)

INCOMPATIBLE WITH A POSITIVELY REINFORCED BEHAVIOR

In malpractice suits against psychiatrists, the most common allegation? (2x)

INCORRECT TREATMENT

Which of the following is the most common reason for malpractice claims?

INCORRECT TREATMENT

The rapid learning demonstrated by children during the schoolEage years is paralleled neurodevelopmentally by which of the following brain processes?

INCREASE IN WHITE MATTER

28 y/o pt on methadone maintenance therapy develops worsening anxiety and fluE like symptoms since switched from valproate to carbamazepine for seizure control 2 weeks ago. What should be the next step in management?

INCREASE THE METHADONE DOSE

What lab finding is most typically associated with NMS?

INCREASED CREATINE KINASE LEVELS

Correlates of a positive response to ECT include which of the following?

INCREASED ECTEINDUCED FRONTAL DELTA ACTIVITY

58 y/o with MDD is getting ECT, develops dense retrograde amnesia after 3rd treatment. How can this be ameliorated?

INCREASING THE INTERVAL BETWEEN ECT TREATMENTS

Concurrent use of phenelzine and meperidine can cause hypermetabolic reaction secondary to what?

INDIRECT PHARMACODYNAMIC EFFECTS AT A COMMON BIOACTIVE SITE

62 y/o F w bipolar d/o develops altered mental status, dysarthria, ataxia in hosp after meds are added in hospital to her lithium. What medication could cause this? (2x)

INDOMETHACIN COMPETES WITH LITHIUM FOR EXCRETION AND CAUSES LITHIUM TOXICITY SYMPTOMS

According to Erikson, a child who strives to be competent by learning new skills, taking pride in results is which stage? (Also correlated with the Freudian stage of latency) (3x)

INDUSTRY VS INFERIORITY

10 y/o pt reports he collects baseball cards. Child is excited b/c he is only one in his peer group who owns several cards. According to Erickson, what developmental task are most relevant for this child? (2x)

INDUSTRY VS. INFERIORITY

Pt who recently delivered a baby BIB to ER, Pt is agitated, labile, and demanding to leave because she said her baby is being poisoned. This condition is considered a psych emergency because of its associated w/?

INFANTICIDE

Integration of clinical and experimental observations in early childhood development supports what statement about infant/parent interactions?

INFANTS ARE BORN WITH SOPHISTICATED PERCEPTUAL ABILITIES THAT FACILITATE ATTACHMENT

What statement about infant/parent interactions is supported by integration of clinical/experimental observations in early child development?

INFANTS ARE BORN WITH SOPHISTICATED PERCEPTUAL ABILITIES THAT FACILITATE ATTACHMENT

An accurate statement regarding assessment for cultural ID:

INFLUENCED BY ONE'S DEGREE OF ACCULTURATION

Psychiatrist to eval pt with bipolar DO who is exhibiting threatening behavior while inpt on CCU for cardiac ischemia. Pt was incarcerated for assaulting and officer, disturbing the peace and firearms violations. Pt verbally threatens to track down his exEgirlfriend and "teach her a lesson she'll never forget." Psychiatrist has legal responsibility to...

INFORM POLICE THAT PT IS IN POTENTIAL DANGER

What if pt asks whether you're still in training during intake interview?

INFORM THE LEVEL OF TRAINING

Pt's spouse calls the patient's psychiatrist to ask about changes in the patient's medication. Which of the following would be an appropriate initial response for the psychiatrist to make? (2x)

INFORM THE SPOUSE THAT THE PATIENT'S CONSENT IS REQUIRED TO DISCUSS TREATMENT

If a third party is supervising a therapy case, the resident should inform the patient that his case will be discussed...A psychiatrist and spouse are attending a concert. During intermission, the psychiatrist sees that they will cross paths in the lobby with one of the psychiatrist's patients. Which of the following would be the most appropriate conduct for the psychiatrist in this situation?

INFORM WALK BY WITHOUT INDICATING KNOWING THE PATIENT FROM, UNLESS THE BEGINNINGPATIENT INITIATES CONTACT.

Neurocognitive functions most likely to show decline in people over 65 years of age?

INFORMATION PROCESSING SPEED

Psychiatrist warns 24 y/o ptE if pt does not sign in to a hospital voluntarily, the patient will be involuntarily committed. This approach violates the spirit of:

INFORMED CONSENT

Serotonergic antidepressants are appropriate treatment for depression in 54 y/o pt with recent coronary artery bypass graft surgery because they: (2x)

INHIBIT PLATELET FUNCTIONING

Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood?

INHIBITED

What characteristic present in a 2 y/o is most likely to persist into adult life?

INHIBITION

Psych MD is asked to evaluate a 37 y/o F who complains of chronic vulvar pain. This pain is accompanied by a burning sensation which is localized to the vestibular region. Pt's husband reports a 12Emonth lack of any sexual intercourse with pt. on psychiatric eval, the pt expresses ambivalence about the lack of intimacy with her husband, and appears somewhat annoyed at him for not understanding how painful sex has become. Pt denies depression or anxiety, but admits to frustration about the pain. The gynecologist reports that a full physical and laboratory workup is remarkable except for pain in the vestibule which can be elicited with touch. Which would be the most reasonable intervention?

INITIATE NORTRIPTYLINE AND SLOWLY TITRATE.

27 y/o uninsured pt was hospitalized in an intensive care unit after a near lethal OD which followed the ending of a longEterm relationship. Pt is medically ready for discharge, but is ambivalent about followEup psych care, noncommittal when asked about regretful feelings for surviving. Best approach?

INPATIENT HOSPITALIZATION

What distinguishes hypochondriasis from delusional d/o, somatic type?

INSIGHT

32 y/o pt w/ hx of treatment resistant depression was brought to ER after overdose on imipramine. Pt reported wanting to die, but then changed her mind and then called for help. Pt's regular psych MD had recently added imipramine to the pt's partially effective regimen of fluoxetine 80mg qday. Pt is afebrile, BP is 100/58 and HR is 96 and regular. Pt is vague about the detail of the attempt, but reports no longer feeling suicidal. Medical resident recommends admission to a psych unit. Request for a TCA blood level and EKG are deferred. Medical resident asserts that the pt's combined imipramine and desipramine level of 750ng/ml is not in the cardiotoxic range. What is the best course of action for the psych MD to take?

INSIST ON FURTHER CARDIAC MONITORING IN EITHER THE ED OR ICU

Major issue with maintaining severely mentally ill in community

INSUFFICIENT RESOURCES

Otto Kernberg's model for tx of patients with narcissistic personality disorder differs from that of Kohut in that in Kernberg's model, the goals of psychotherapy include:

INTEGRATING IDEALIZATION AND TRUST WITH RAGE AND CONTEMPT

24y/o ColombiancAmerican is concerned about how to maintain his parent's cultural heritage after he marries a Caucasian. Which type of acculturative stress is he dealing with? (4x)

INTEGRATION

According to Erikson, person >65 w sense of satisfaction that life was productive/ worthwhile has successfully managed psychosocial task of developing: (4x)

INTEGRITY

To define learning disability, look for discrepancy between:

INTELLECTUAL POTENTIAL AND PERFORMANCE

A difficult child, according to Thomas and chess's categories of temperament, expect what characteristics?

INTENSE EXPRESSION OF MOOD

According to Thomas & Chess' categories of temperament, the difficult child shows what characteristics?

INTENSE EXPRESSIONS OF MOOD

Describe the psychiatric assertive community treatment case management model: (2x)

INTERDISCIPLINARY TEAM, SERVICES IN SITU, HIGH STAFF/PATIENT RATIO, AND INTENSIVE OUTPATIENT RESEARCH

Which med is used to treat hep C viral infection and is associated with depression, anxiety, and cognitive impairment?

INTERFERONEALPHA

Thematic apperception test is used for

INTERFERRING MOTIVATIONAL ASPECTS OF BEHAVIOR

In 8E11 y/o kids, which moral skill is the 1st one to fully develop?

INTERNALIZATION OF PARENTAL VALUES

Comprehensively researched therapy for mood d/o's

INTERPERSONAL PSYCHOTHERAPY

Therapeutic focus on the on pt's current social functioning is most characteristic of:

INTERPERSONAL PSYCHOTHERAPY

Psychotherapy where pts realistically evaluate their interactions w others & therapist offers direct advice/helps pts make decisions/ignores transference issues. (2x)

INTERPERSONAL PSYCHOTHERAPY (IPT)

Abnormality in what domains is the most important in establishing the Dx of autistic do?

INTERPERSONAL RELATIONS

26 y/o pt with depressed mood and dissatisfaction with life, feeling isolated and having few friends who is not under undue stress and historically copes well with personal problems would benefit from what type of psychotherapy?

INTERPERSONAL THERAPY

75 y/o pt has begun to experience insomnia and fatigue after the death of her husband. She describes feeling "down in the dumps". She was previously active with many friends and social outlets. Psych MD decides that treatment should focus on pt's grief as the primary problem in order to aid mourning and facilitate pt's reintroduction into outside activities and relationships. What mode of psychotherapy would best address these goals of treatment?

INTERPERSONAL THERAPY

A treatment modality explicitly emphasizes giving pts a formal psych Dx and assigning them sick role.

INTERPERSONAL THERAPY

Intentionally assigning the sick role to a pt which serves to give the pt the permission and responsibility in order to recover is a tenet of which form of psychotherapy?

INTERPERSONAL THERAPY

Young female in psychodynamic psychotx admitted to seeing the resident downtown last weekend, followed him around, thinking she could later shop at the same stores and eat at same places as her greatly admired therapist. Pt not dangerous, convincingly apologized, stated that she would never repeat this behavior and hoped therapist would not "fire" her. Next step therapist should take?

INTERPRET PATIENT'S LONGING TO IDENTIFY WITH THE THERAPIST.

Female psych resident says pt saw resident in town over weekend. Followed her around. Thought she could later shop at same stores and eat at same restaurants as her greatly admired therapist. Nothing wrong in pt's bx or material suggesting she is dangerous. Pt apologizes convincingly, says will not do again. Hopes therapist will not fire her. What is next best step?

INTERPRET PT'S LONGING TO IDENTIFY W THE PSYCHIATRIST

A 45 y/o with dysthymic d/o is undergoing a course of brief dynamic psychotherapy. In the 2nd session, pt discusses how his father was never available to him. Later, when the therapist has to cancel an appointment due to unforeseen trip, the pt becomes irritated and wonders aloud whether he should continue session with the therapist. Which of the following would be the most appropriate response for the psychiatrist to make to the pt's irritation?

INTERPRET THIS TRANSFERENTIAL RESPONSE AND INVITE THE PT TO DISCUSS IT FURTHER

Primary intervention in highly expressive psychotherapy:

INTERPRETATION

The LEAST utilized approach used in cognitive therapy in pt w/ substance dependence

INTERPRETATION OF INTERACTIONAL PROCESS

Pt sees therapist and makes threats and becomes agitated. Therapist feels uneasy, the next step is to:

INTERRUPT INTERVIEW TO GET HELP

In the Institute of Medicine classification system developed to clarify different aspects of prevention, the category of "indicated interventions" refers to which of the following?

INTERVENTIONS THAT FOCUS ON HIGHERISK INDIVIDUALS TO ENHANCE RESILIENCE AND PREVENT ONSET OF THE ILLNESS

Ethical standards dictate that the psychiatrist should do what in child custody evals?

INTERVIEW ALL PARTIES TO THE LITIGATION

In the US, which of the following is the most common precipitant of PTSD in children and adolescents?

INTRAFAMILIAL VIOLENCE

Defense mechanism that involves internalizing the qualities of an object?

INTROJECTION

Person estimating usefulness of tx study will use number needed to treat statistic to represent number of pts who need to be treated to produce one additional good outcome beyond that obtainable w control for comparison condition. NNT formula?

INVERSE OF THE ABSOLUTE RISK REDUCTION

"Which is a boundary violation? • Investing in a pt's business • Treating the town pharmacist in small rural town • Accepting pt's holiday gift of handEmade scarf • Seeing one pt at reduced fee and charging others more • Discussing a pt's sexual feelings toward the psychiatrist in session "

INVESTING IN A PT'S BUSINESS

31 y/o postpartum F distressed by fantasies of smothering baby, tearfully describes feeling overwhelmed by the burden of the child care. She denies SI/HI, but describes feeling some evil external force taking her baby away. Requests outpt psych f/u & refuses voluntary admission> her husband says everything is fine. Next step:

INVOLUNTARY ADMISSION

Apoptosis of cortical neurons differs from necrosis in that it: (2x)

INVOLVES EXPRESSION OF SPECIFIC GENES

During the initial phase of interpersonal psychotherapy (ITP), what problem is the therapist most likely to identify for therapeutic focus with the patient?

IPT INITIAL PHASE: ROLE TRANSITION

In the middle phase of interpersonal psychotherapy (IPT), the therapist focuses on the patient's: (4x)

IPT MIDDLE PHASE: CURRENT RELATIONSHIPS

5 y/o child experiences death of grandmother. Child asks, "When can I talk to Grandma again?" This reflects an incomplete understanding of what concept of death?

IRREVERSIBILITY

Which characterizes the defendant's competency to stand trial in criminal proceedings?

IS PRESUMED UNLESS THE ISSUE IS RAISED

The purpose of reflective statements during patient interview is for

IS TO ENSURE WHAT THE PATIENT SAID IS UNDERSTOOD

Young man recounts how his father kicked his puppy to death, no emotion when telling the therapist this despite therapist's upset response. Defense mech? (3x)

ISOLATION OF AFFECT

Which of the following is the most significant problem with the use of the global assessment of functioning scale?

IT CONFOUNDS SYMPTOMS AND FUNCTIONING

Appropriate substance abuse treatment in the clinical setting has been addressed in landmark legal cases. What is the consensus?

IT IS AMONG THE RIGHTS GRANTED AS IT IS CONSIDERED A PSYCHIATRIC DISORDER

42 y/o pt with hx of HTN treated with HCTZ and lisinopril presents for f/u of severe melancholic and vegetative depression. The patient, while adherent to all med regimens, has failed multiple combos of antidepressants and is currently on a regimen that includes fluoxetine. The psychiatrist plans to discontinue fluoxetine and start selegiline. The most important consideration to be made before starting?

IT IS AN IRREVERSIBLE MAOEA & MAOEB INHIBITOR AND CAN ONLY BE STARTED 5 WEEKS AFTER DISCONTINUING FLUOXETINE TO DECREASE RISK OF SEROTONIN SYNDROME

Which of the following statements reflects the APA position statement on reparative conversion therapy for gay and lesbian individuals?

IT IS CONSIDERED UNETHICAL BECAUSE HOMOSEXUALITY IS NOT CONSIDERED A MENTAL DISORDER AND HARM OFTEN COMES FROM SUCH TREATMENT

Which of the following is the most accurate information on the use of biofeedback for hypertension?

IT IS EFFECTIVE FOR HYPERTENSION, HOWEVER, IT IS LESS EFFECTIVE THAN MEDICATION

Pt who is poor but talented asks if he can barter for services. You like the pt's product. What describes the nature of this proposal to accept goods in lieu of fees

IT IS NOT RECOMMENDED AS IT MAY COMPROMISE TREATMENT BOUNDARIES

The most valid criticism of relying on a noEharm contract to determine a pt's suicide potential:

IT LACKS ANY SIGNIFICANT EMPIRICAL EVIDENCE TO SUPPORT ITS US

During initial psych interview, pt tearfully discusses painful ending of romantic relationship. What should Dr. say to establish therapeutic alliance?

IT SOUNDS LIKE THIS HAS BEEN VERY DIFFICULT FOR YOU. HOW ARE YOU COPING?

Psych MD asked pt "what would you do if you lost your prescription?" This question primarily assesses:

JUDGMENT

Mental competency of an elderly patient is determined by: (6x)

JUDICIAL HEARING

The efforts of psychiatrists to achieve "parity" legislation for mental illness can best be seen as illustrating which of the following moral principles?

JUSTICE

A psychiatrist employed by an institution wants to use pt data for research later. How can she get the progress notes?

KEEP HER OWN SEPARATE RECORDS

Unmarried nulliparous woman participates actively in rearing of her siblings. According to Darwinian theory, such altruistic behavior explained by what concept?

KIN SELECTION

Acculturation outcomes associated with pt's high risk for suicide, substance abuse, and alcoholism:

LACKING STRONG ALLEGIANCE TO NATIVE CULTURE AND NOT INCORPORATING HOST CULTURE

Acculturation outcome associated with high risk for suicide, substance abuse, and alcoholism

LACKING STRONG ALLEGIANCE TO NATIVE CULTURE, AND NOT INCORPORATING HOST CULTURE

Ability of preschool children to regulate emotions is most strongly enhanced by the development of:

LANGUAGE

The long-term outcome in autism is most closely correlated with?

LANGUAGE DEVELOPMENT

What is most important when trying to differentiate between autism and Asperger's? (6x)

LANGUAGE DEVELOPMENT

Which statistical method attempts to address the effects of participants dropping out of a study prior to completion? (5x)

LAST OBSERVATION CARRIED FORWARD

Stage of development associated w/ setting up clubs, making rules

LATENCY

What developmental period does the child realize he/she is the child of his/her parents and the child's parents have a relationship with one another?

LATENT

Free RBCs protoporphyrin test in the screening for intoxifiication with:

LEAD

A 4th grade child is falling behind peers. Child has IQ of 92, but lower than expected scores on achieve tests and adaptive functioning. Teacher reports child voices understanding of material, but struggles with homework, what is child's diagnosis?

LEARNING DISABILITY

Pt's family believes depression is 2/2 santeria curse. During assessment, psych should focus on...

LEARNING FROM PT AND FAMILY WHAT THEY BELIEVE THE COURSE OF THIS ILLNESS IS EXPECTED TO BE

Pt scores on revised Wechsler adult intelligence scale (WAISER) subtests for picture arrangement and block design are very low compared to scores on other subtests. Most suggestive of:

LESION IN NONDOMINANT HEMISPHERE

When compared to younger adults, anxiety disorders in adults over age 65 have:

LESS COMORBIDITY WITH ALCOHOL ABUSE

Pt is taking MMPIE2 intentionally endorses items that reflect social desirability. Which scales to catch this pattern of item endorsement?

LIE SCALE

Interpersonal social rhythm therapy in bipolar focuses on what?

LIFESTYLE REGULARITY

Aggressive behavior in preschoolers w otherwise NML development usually due to:

LIMITED VERBAL ABILITIES

Business executive hospitalized for bleeding ulcer repeatedly argues with a wellcliked head nurse and threatens to leave AMA. Best action for C&L psychiatrist is: (2x)

LISTEN TO PT'S COMPLAINTS ACKNOWLEDGE HIS DISCOMFORT WITH THE PASSIVE POSITION THAT HE IS UNACCUSTOMED TO

28yo homosexual M reports being victim of domestic violence and has not reported. What is the best response for the psychiatrist to make?

LISTEN TO PT'S CONCERNS AND EXPLORE THEM

47y/o pt w acute mania is unresponsive to pharmacotx. Pt's current med regimen includes lithium, divalproex, clonazepam, olanzapine, bupropion. ECT is begun, pt is continued on previous med regimen. After 2 ECT tx, pt becomes delirious. Cause? (x3)

LITHIUM

55 y/o pt with guilt, anhedonia, insomnia, and sad mood has been treated for 10 wks with fluoxetine 60mg qam. His mood and appetite have improved, though he still has difficulties with concentration, hopelessness, and tearfulness. He denies a h/o manic or psychotic symptoms. The medication most likely to augment the antidepressant effect of his current regimen would be:

LITHIUM

A 32 yo F comes to the ED with CC of 2 weeks of diarrhea. On exam she is anxious and tremulous and is not oriented to date or time of the day. She states she is taking "some drug" for dipolar disorder and adds that she started doubling her dose a month ago because she "wasn't getting better fast enough." She denies use of drugs/ETOH. Which medication would most likely cause the symptoms described?

LITHIUM

A psychotropic with same pharmacokinetic properties in Asian Americans and White Americans

LITHIUM

Administration of activated charcoal is ineffective in overdose of:

LITHIUM

Giving charcoal is an ineffective treatment for pt who OD'd on:

LITHIUM

Med that is assoc w prolonged seizures/confusional state during ECT:

LITHIUM

Medication most likely to cause cognitive side effects if taken at same time as ECT:

LITHIUM

Psoriasis exacerbated by: (2x)

LITHIUM

Which med is thought to have a protective effect independent of its moodc stabilizing effect against suicide risk in pts w mood disorder? (4x)

LITHIUM

Which med should be held before ECT?

LITHIUM

Which of the following medications was first used as a treatment for gout and later promoted by john cade for treatment of unstable mood?

LITHIUM

Medications for Tx of aggression in an individual w/ MR

LITHIUM, THIORIDAZINE, HALDOL, PROPANOLOL (NOT CLONAZEPAM)

Pt is admitted to ICU. Pt can communicate but is deemed incompetent. Which of the following advance directives should be used to inform the hospital staff of pt wishes?

LIVING WILL

According to a metaEanalysis published in 2008 including patients with personality disorder, multiple mental disorders and chronic mental disorder, which of the following psychotherapies was considered most effective in improving overall outcome, target problems, and personality functioning?

LONGETERM PSYCHODYNAMIC PSYCHOTHERAPY; CBT; DBT; FAMILY THERAPY

Benzo that would be the safest to prescribe for a 70y/o pt:

LORAZEPAM

Benzo w/o active metabolites

LORAZEPAM

If prescription benzo is necessary for a patient w/ severe hepatic dysfunction which of the following is most appropriate choice to avoid elevated serum levels. (2x)

LORAZEPAM

Pt w/ h/o bipolar presents w immobility, posturing, echopraxia. First line tx? (5x)

LORAZEPAM

Which benzo is reliably absorbed given IM?

LORAZEPAM

Which benzodiazepine is metabolized through glucuronidation (phase II metabolism) in the liver?

LORAZEPAM

An intoxicated pt in ER throws a food tray at security guard, no respond to verbal redirection and refused to take meds by po. Pt is now pacing, cursing and threatening to "hurt someone". The most appropriate meds:

LORAZEPAM 2MG IM, REPEATED IN 45 MIN IF NO RESPONSE

Common theme in psychotherapy in the elderly: (2x)

LOSS

Which commonly precipitates suicide in the elderly?

LOSS

Intimate partner violence is most common in which of the following demographics ?

LOW INCOME FAMILIES

IV Haldol related torsades de pointes is associated with what?

LOW MAGNESIUM LEVELS

In studies that compare SSRI antidepressants with TCAs, which of the following is the best documented advantage of SSRIs over TCAs?

LOWER DROP OUT RATES DUE TO SIDE EFFECT

Prevalence of psychotic disorders after age 65 is:

LOWER IN BOTH MEN & WOMEN

When compared to younger age groups, the prevalence estimates of MDD in persons older than 65 years are:

LOWER IN BOTH MEN AND WOMAN

Primary advantage of treating childhood enuresis with behavioral methods vs desmopressin (2x)

LOWER RATES OF RELAPSE

60 y/o pt w/ depression and paranoia is being treated with 50mg of sertraline and 6mg of resperidone. At f/u appointment, pt c/o slowed thinking and excessive salivation. On exam, the pt exhibits a masked facies and cogwheel rigidity. Mood and paranoia have significantly improved. The next step for the psych MD?

LOWER THE DOSE OF THE ANTIPSYCHOTIC MEDICATION

SSRIs with the greatest potential for slowing or blocking metabolism of other medications?

LUVOX

The rule that finds people not guilty by reason of insanity due to mental illness that impaired their knowledge of the nature quality and consequences of their actions or they were incapable of realizing that these acts were wrong is called what?

M'NAGHTEN RULE

Murder trial, defendant states "I think murder is wrong but killing a spy from Mars who is trying to steal the secret of life is right." This poses a problem for what type of evaluation of criminal responsibility?

M'NAUGHTEN RULE

What causes of decreased vision in older adults is characterized by an inability to focus on an object as a result of retinal damage

MACULAR DEGENERATION

While taking lithium patients should:

MAINTAIN SODIUM INTAKE

In Operant Conditioning, a partial or intermittent reinforcement schedule results in:

MAINTAINING A BEHAVIOR THAT IS RESISTANT TO EXTINCTION.

Best protection against malpractice law suit:

MAINTAINING GOOD DOCTOREPT RELATIONSHIP

Which of the following produces best outcome in terms of drug consumption and criminal behavior for heroinEdependents?

MAINTAINING OF METHADONE

Winnicott's notion of capacity to be alone in presence of another person pertains to:

MAINTENANCE OF ONE'S IDENTITY AMONGST OTHERS

Testamentary capacity refers to person's ability to (4x)

MAKE A WILL

Which of the following actions is most important for preventing suicide in adolescence?

MAKE IT A GUN FREE HOME

Goals of initial dialogue w/ doc requesting consult except;

MAKING SURE FAMILY IS NOT PRESENT

Discontinuation syndrome associated with SSRI consists of:

MALAISE, NAUSEA, PARESTHESIAS, DIZZINESS, MOOD SYMPTOMS, AND HEADACHE

25 y/o prisoner who claims to be depressed is hospitalized after he swallowed some razor blades. The razor blades are found to have been carefully wrapped in surgical tape before the pt swallowed them. Later, the pt confesses he swallowed the blades because he wanted some time out of prison:

MALINGERING

The National Practitioner Databank contains reports about which of the following types of physician problems?

MALPRACTICE SETTLEMENTS WHERE NO WRONG WAS ADMITTED

According to C.G. Jung, anima refers to:

MAN'S UNDERDEVELOPED FEMININITY

According to Freud, what is a dream that is remembered on wakening?

MANIFEST DREAM

Normal autism, symbiosis, differentiation, and practicing are among the developmental subphases of separation and individuation proposed by what theorist?

MARGARET MAHLER

29 y/o complains about mistreatment from boyfriend. Proud of generous nature but complains how little she gets back. Therapist finds it hard to make her selfEreflective about her role in this, gets frustrated and fatigued. Patient displays:

MASOCHISM

Capacity to inhibit behavioral responses improves over course of adolescence most likely because of

MATURATION OF PREFRONTAL CORTEX

Studies show that shortEterm psychodynamic psychodynamic (STPP) psychotherapy is superior to supportive therapy in the treatment of complicated grief for certain pts. Which of the following pt characteristics predicts a better response to STPP than supportive therapy?

MATURE OBJECT RELATIONS

Dx for 9yo boy w/ irritability and aggression, failing grades, and hearing a voice saying he is bad.

MDD

What psychiatric illness is the leading cause of disability in persons 15E44y?

MDD

In a skewed distribution this is a measure of central tendency and moves furthest away from the mode in the direction of skewness:

MEAN

Use of meds with psychodynamic psychotherapy optimal when:

MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT'S UNDERSTANDING

The concept of lifetime prevalence refers to the number of persons:

MEASURED AT A POINT IN TIME, WHO HAD A D/O AT SOME POINT DURING THEIR LIVES.

50 y/o pt with myasthenia gravis and a 3Eday hx of cough, lowEgrade fever and chills, presents with great difficulty breathing. The pt appears tired and anxious, and the pt's skin is clammy and sweaty. Initial management?

MECHANICAL VENTILATION

Measure of central tendency that might best be used to analyze an outcome measure with significantly skewed distribution of its values?

MEDIAN

Ten pts are given daily doses of a single antidepressant until their mood becomes euthymic. Eight pts respond to 1mg, one pt responds to 5mg, and one pt responds to 10mg. The best reflects the skewed distribution of effective dose in this group of pts?

MEDIAN

Gay couple seeks therapy. One has HIV, one is negative. HIV negative feels betrayed and believes HIV positive partner was unfaithful. What should therapist say?

MEDIAN DURATION OF ASYMPTOMATIC STAGES OF HIV INFECTION IN THE US IS 10 YEARS

LongEterm nursing home care in the U.S. is primarily funded by what entity?

MEDICAID

A psych is asked to see a general medical inpt for reported hypochondriasis. Which of the following is the most important differential diagnostic consideration?

MEDICAL CONDITION

Psychiatrist sees family of a pt who is in vegetative state. All staff, except one nurse, & all of family, except one adult child, believe it is "time to let go." But nurse & adult child claim signs of recognizing & responding to them despite all of the evidence of cortical brain death. Most appropriate next step?

MEET SEPARATELY WITH FAMILY AND STAFF TO EXPLORE THEIR ISSUES WITH POLARIZATION

How do you resolve a mixed decision for among staff and family of a dying patient (continue Tx vs let die):

MEET SEPARATELY WITH FAMILY AND STAFF TO EXPRESS ISSUES OF POLARIZATION

A therapist conceptualizes patients' depression as related to guilt at having acted harmfully toward loved ones. Which theorist most likely influenced this therapist:

MELANIE KLEIN

8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)

MELATONIN

Which is an NMDA receptor antagonist? (2x)

MEMANTINE

Which of the following agents used to treat patients with alzheimers disease has a mechanism of action related to an antiglutaminergic mechanism?

MEMANTINE

Informed consent requires: presentation of information, voluntary consent from patient, and:

MENTAL COMPETENCE

The three component of informed consent include: the presentation of information, the voluntariness of consent on the part of pt, and:

MENTAL COMPETENCE

What is the relationship of violence to mental d/o?

MENTAL D/O HEIGHTENS RISK IN SOME, DECREASES RISK IN OTHERS

Which of the following is seen most frequently as a comorbid condition in children with autism? (5x)

MENTAL RETARDATION

Pt in individual psychotx describes hatred for a "mean, unfair" boss. This time pt adds, "but actually, I have heard my boss talking to others in the office, and he seems pretty much ok - even his voice sounds so different from the way I hear him in my head!" According to Fonagy, pt is demonstrating which mental activity? (2x)

MENTALIZATION

Primary process thinking is characterized as ...

MENTATION FOCUSED ON DRIVES AND WISH FULFILLMENT

Results are combined from a number of studies of similar design. An overall estimate of the effect of a variable is made which incorporates the information provided by all the studies. The procedure is termed?

METAEANALYSIS

What relies on statistical review/interpretation of multiple study results?

METAEANALYSIS

Most common cause of brain tumor in a 65 yrEold M?

METASTATIC LUNG CARCINOMA

35 y/o pt with hx of opioid and alcohol dependence presents to the emergency department complaining of tremlousness, anxiety, nausea and vomiting. Used large amounts of heroin and alcohol the day prior. Initial preferred medication for opioid withdrawal?

METHADONE

DrugEdrug interactions in pts taking HIV meds are particularly problematic with which medication:

METHADONE

Pregnant pt dependent on heroin presents for treatment, wants to do what's best for baby. What is safest treatment for both mother and unborn baby? (2x)

METHADONE MAINTENANCE FOR THE DURATION OF THE PREGNANCY

22 y/o heroin dependent female discovers she is pregnant and wants to detox. What way would you recommend? (4x)

METHADONE MAINTENANCE UNTIL DELIVERY THEN DETOXIFICATION

What barbiturate is used in ECT to produce a light coma?

METHOHEXITAL

10 y/o girl w/ hep B is evaluated for persistent difficulty w/ schoolwork since 1st grade. Often looses homework, seems not to listen to parents or teachers. If needed treatment what will you give?

METHYLPHENIDATE

Initial pharmacological therapy for child with high energy, impulsivity, a short fuse when frustrated, frequent angry outbursts, and careless homework mistakes.

METHYLPHENIDATE

Treatment for apathy without accompanying depression, which also has been known to precipitate a tic disorder: (2x)

METHYLPHENIDATE

Psychiatrist is called to eval a pt on a medical floor who has developed acute dysarthria w/ protruding tongue and torticollis. Which med is suspect? (2x)

METOCLOPRAMIDE

Child presents w/ moderate intellectual disability, deficits in visualcspatial processing, high levels of anxiety, a phobia, and is highly sociable. Which genetic d/o? (2x)

MICRODELETION ON CHROMOSOME 7q11.23 (WILLIAMS SYNDROME)

6 y/o child in 1st grade is doing very poorly. WISCER IQ score is 60. Compared with other children his age he has sig. impairment in social skill, dressing, language, and feeding. What is the Dx?

MILD MENTAL RETARDATION

Which test is an objective measure of personality in adults and is helpful in confirming diagnosis of personality disorder? (3x)

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)

Sexual behavior abnormal in a preschooler?

MIMICKING SEX WHEN PLAYING

According to DBT theory, which skill should be taught to pts first & regularly practiced in order to facilitate learning of other skills?

MINDFULNESS

Which of the following psychological tests has been validated for adolescents, elderly and ethnic minority groups, and is recommended for the assessment of psychological functioning in patients from diverse cultures?

MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPIE2)

A female child performs a dance for her mother and basks in the gleam of her mother's eyes. According to selfEpsychology, the child is having an experience of:

MIRRORING

Child dances for mother & basks in gleam of mother's eyes. According to selfE psychology, experiencing:

MIRRORING

Which is the most common mitochondrial disorder (of 4 listed)?

MITOCHONDRIAL ENCEPHALOPATHY, MYOPATHY, LACTIC ACIDOSIS, AND STROKEELIKE EPISODES (MELAS)

What factor is thought to predict a poor response to lithium treatment for pts with bipolar disorder? (2x)

MIXED MANIC/DEPRESSED EPISODE

Psychiatrist is evaluating a 5 y/o child in kindergarten. Child does well with puzzles and other performance activities. Teacher reports that the child has a limited vocabulary and immature grammar in comparison to the other children. Child interacts well with other children. The child also seems to have some trouble understanding questions. Child's hearing and vision are normal. Explanation?

MIXED RECEPTIVE & EXPRESSIVE LANGUAGE D/O

Measures testEtaking attitudes

MMPI

Objective psychological test

MMPI

What psychological tests measure testctaking attitudes at time of exam (2x)

MMPI (MINNESOTA MULTIPHASIC PERSONALITY INVENTORY) VALIDITY SCALE

Best describes the role of the observing ego:

MOBILIZES DEFENSE MECHANISMS IN RESPONSE TO SIGNAL ANXIETY

SelfEdisclosure by therapist may be appropriate in order to do what?

MODEL APPROPRIATE BEHAVIOR AND FOSTER THERAPEUTIC ALLIANCE

Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Which learning principal?

MODELING

An effective role of C&L psychiatrist consulting on a manipulative, entitled patient?

MODELING AN APPROACH OF APPEALING TO THE PATIENT'S ENTITLEMENT

Phineas Gage, who had an iron bar shot through his skull in an explosion in 1848 and subsequently showed profound changes in behavior, is still of interest today because of its implications for (4x)

MODERATE

Person w/ MR who achieves 1st grade education fits which diagnostic classification?

MODERATE MENTAL RETARDATION

Which population has highest prevalence of Schizophrenia?

MONOZYGOTIC TWIN OF SCHIZOPHRENIC PT

Which area of MSE relies primarily on patient report?

MOOD

Which d/o is the most common among pts who complete suicide: (4x)

MOOD

Philippe Pinel's A Treatise on Insanity described a new approach to treating the institutionalized mentally ill that focused on generating a therapeutic environment. Pts were persuaded to follow a daily schedule that included education and occupational activities. This approach was termed which of the following?

MORAL TREATMENT

Cognitive developmental tasks of adolescence include acquiring the capacity for:

MORE COMPLEX UNDERSTANDING OF CAUSALITY & MULTILEVEL REALITIES

Pts > 65 years w bipolar disorder differ from younger pts w same dx—how?

MORE MIXED EPISODES

Most common complaint in southeast Asians who are dx w/ mental disorder is:

MULTIPLE SOMATIC SYMPTOMS

What has been shown to be an evidenceEbased treatment for individuals with conduct d/o?

MULTISYSTEMIC THERAPY

Diphenhydramine's ability to treat acute dystonia is due to action on which receptor?

MUSCARINICE1

The development of full postural control in children by 4 yrs old correlates neuroanatomically with the developmental maturity of what?

MYELINATION OF CEREBELLAR FIBERS

35 y/o pt is started on a trial of clozapine for treatmentErefractory schizoaffective disorder. During the initial medication titration, pt complains of sedation and orthostatic hypotension as well as fluElike symptoms, but seems symptomatically improved. However after a dose increase from 150 to 200mg, pt develops a fever to 102 degrees, tachycardia to 130bpm, and an acute metal status change. CXR, urine studies, and blood culture are unremarkable. A CBC reveals a WBC of 11.4, with an elevated eosinophil percent of 7%. Which known toxic risk of clozapine is the most likely Dx?

MYOCARDITIS

The most prominent lobbying and support organization for families of people with severe psychiatric disorders is the:

NATIONAL ALLIANCE FOR THE MENTALLY ILL (NAMI)

A physician is disciplined by a hospital at which he practices for issues related to car provided to a pt. if the disciplinary action lasts more than 30 days, the hospital must report the physician to which of following:

NATIONAL PRACTITIONER DATA BANK

Racial/ethnic group with highest rate of suicide?

NATIVE AMERICANS

Research into the complexity of healthcare systems and distribution of resources is best carried out in which fashion?

NATURALISTIC STUDY

An 80 y/o pt presents with sudden onset seizures, hallucinations and aggressive behavior. A preliminary CT scan of head does not show abnormalities. The pt's family wants to know what is the likelihood that the pt has no changes in his brain given the CT scan. Which of the following concepts would need to be used to respond to the family's concerns about the CT scan results?

NEGATIVE PREDICTIVE VALUE

40 y/o pt experiences recurrent panic attacks usually in public places. The pt leaves the area whenever a panic attack begins and then the panic Sx stop. This demonstrates which of the following types of learning patterns?

NEGATIVE REINFORCEMENT

A child practices violin to prevent parents nagging, what does this describe?

NEGATIVE REINFORCEMENT

CognitiveEbehavioral explanation of trichotillomania suggests hair pulling reduces an uncomfortable tension that the child is experiencing. What is this an example of?

NEGATIVE REINFORCEMENT

The evolution of addiction from an impulsive to a compulsive act is characterized by the increasing importance of which of the following factors?

NEGATIVE REINFORCEMENT

This best describes the technique of reframing in family therapy:

NEGATIVELY EXPRESSED FEELING OR BEHAVIORS ARE EXPRESSED IN POSTIVE TERMS

Which type of child maltreatment is most prevalent? (2x)

NEGLECT

Most common factor in cases of termination of parental right: (2x)

NEGLECT BY THE PARENT

The most common cause of severe polyuria with lithium is:

NEPHROGENIC DIABETES INSIPIDUS

Puerto Rican and other Latin American pts are more likely than those from other western cultures to report depression as:

NERVOUSNESS

Puerto Rican and other Latin American pts are more likely than those from western culture to report their depression as what?

NERVOUSNESS

Most typical SE of fluoxetine:

NERVOUSNESS, RESTLESSNESS, AND ANXIETY

Fetal exposure to valproate during pregnancy increases risk of:

NEURAL TUBE DEFECTS

Teratogenic effect of both VPA and carbamazepine: (2x)

NEURAL TUBE DEFECTS

Biological consequences of psychological stress affect which mechanism?

NEUROEIMMUNOEENDOCRINE FUNCTION

Recent schizophrenic med adjustment, now with fever, diaphoresis, stiffness, tachycardia, confusion. Dx?

NEUROLEPTIC MALIGNANT SYNDROME

BenderEGestalt diagrams assesses:

NEUROPSYCHOLOGICAL IMPAIRMENT

Disassociation is what type of defense mechanism?

NEUROTIC DEFENSE

Skin tumors, abundant café au lait spots, Lisch nodules on iris is diagnostic of mutation on which gene:

NF-1 (NEUROFIBROMATOSISE1 GENE)

27 y/o F has multiple brown popular lesions on the face, neck, shoulders that have developed over years. Has b/l hearing loss, b/l limb and gait ataxis. MRI w/ gadolinium shown on test and has b/l enhancing masses. Pt is a carrier of a mutation in which gene? (3x)

NFc2 (NEUROFIBROMATOSIS 2 GENE)

28 y/o pt wants to stop smoking with the help of a nicotine replacement product. Pt plans to have orthodontia within the next 2 months; has psoriasis; and has multiple environmental allergies that often cause nasal stuffiness, sore throats, and itchy, watery eyes. Nicotine replacement best?

NICOTINE LOZENGES

Patient with long history of treatment resistant depression on phenelzine complaining of sweating, palpitations, and headache. BP = 210/118. Recently took OTC medicine to treat URI. What is the most appropriate intervention?

NIFEDIPINE

Pt taking tranylcypromine for atypical depression called Psych MD, reports HA, vomiting, chills, palpations over one day. Pt asks if he continue med during illness. In addition to directing pt to stop med, emergent Tx would 1st include what med?

NIFEDIPINE

Association b/w Beta blocker and depression

NO ASSOCIATION SUPPORTED

Male sexuality in the seventh decade is characterized by which of the following?

NO CHANGE IN SEX DRIVE

Which controlling for health status, which of the following best describes the relationship between retirement and subsequent mortality risk?

NO INCREASE IN MORTALITY RISK

Nephrologists most commonly request psych consult on patients with end stage renal disease for which of the following conditions?

NONCOMPLIANCE

Patient threatens criminal behavior toward property of another. Legal obligation of psychiatrist?

NONE

Fact that participants did NOT receive available indicated treatment in the Tuskegee Syphilis study is an ethical violation of justice, beneficence or nonEmalfeasance?

NONEMALEFICENCE

What does NOT predict violence?

NONEVIOLENT CRIMINAL ACTIVITY

"First do no harm" refers to which of the following principles: (2x)

NONMALEFICENCE

"Primum no nocere" (first do no harm) refers to which core ethical principle?

NONMALEFICENCE

Watson's experiment with "Little Albert" demonstrated that an 11 y/o child, who previously shown no phobic response to a stimulus, learned to fear the stimulus after it was repeatedly paired with a loud noise. This would be unethical b/o violation of: (2x)

NONMALEFICIENCE

In the analysis of results of the national comorbidity study (1994), a nonresponse adjustment weight was included. This inclusion was important for what reason?

NONRESPONDERS WERE FOUND TO HAVE HIGHER RATES OF ILLNESS

Strong correlation between Asperger's and? (7x)

NONVERBAL LEARNING DISABILITY

Father is concerned about 6 y/o son because child is rubbing genitals while in bathtub. This has not occurred at school or in public. Explanation of behavior?

NORMAL BEHAVIOR.

Transient homosexual/heterosexual experiences in heterosexual/homosexual adolescents respectively are best understood as?

NORMAL EXPERIMENTATION IN SEXUAL IDENTITY

5 y/o child several month after that he lost his mother in a MVA reports that his mother is watching him from sky every day is and example of:

NORMAL GRIEF

60 y/o lost spouse 2 wks ago - sadness comes and goes

NORMAL GRIEF

Research shows dissociative symptoms most commonly represent what worldwide?

NORMAL PART OF RELIGIOUS/RITUAL EVENT

The father of a 3 1⁄2 year old boy who attends preschool reports that on several occasions the boy has come into the bathroom while the father is in the shower interested in observing his father's genitals asking once "why is it so fat?" This behavior most likely is an indication of?

NORMAL PRESCHOOL AGE SEXUAL INTEREST

The birth of a new sibling is associated with the recurrence of toileting accidents in a 3 y/o who has previously been successfully trained:

NORMAL REGRESSION

While assessing for DV, examiner says to pt/spouse, "The tension that builds up between you must be incredibly stressful. It's not unusual that people who are stressed out can have trouble controlling themselves or can do things they didn't intend, like screaming at or even hitting their partner. Has anything like that happened to you?" Which technique is this?

NORMALIZATION

4 1⁄2 y/o child, playing alone at home with some toy cars, is observed by parents to be speaking out loud while playing, excitedly making comments such as, "let's go so fast that the monster will never catch us." This type of speech most likely represents:

NORMATIVE ASPECT OF PRESCHOOL PLAY

Which stage of group development has been met when members are less afraid of revealing individual differences so they can participate in experiential learning?

NORMING

A known limitation of the Minnesota Multiphasic Personality Inventory?

NORMS DO NOT ACCOUNT FOR OUTCOMES BASEC ON RELIGION AND RACE

Blood levels for therapeutic and potentially toxic effects can routinely be assessed for which med?

NORTRIPTYLINE

What drug has a curvilinear therapeutic window? (6x)

NORTRIPTYLINE

According to APA guidelines, sexual relationships with pts are

NOT ALLOWED WITH CURRENT OR FORMER PTS

Impaired physician fails to obtain/benefit from treatment may require eval from administrative psychiatrist. what is different about administrational psychiatrist compared to typical psychiatrist?

NOT BOUND BY USUAL PARAMETERS OF CONFIDENTIALITY

APA addressed ethics of sexual relationships between psychiatrists & pts by stating

NOT PERMISSIBLE TO HAVE A SEXUAL RELATIONSHIP WITH A CURRENT OR FORMER PATIENT

29 y/o severely depressed with SI. Threatens to kill his wife and daughter to "take them with me." Legal responsibility:

NOTIFY THE WIFE

Assuming there is no significant difference btwn 2 random samples of population is:

NULL HYPOTHESIS

The most important feature of post natal brain development is an increase in what?

NUMBER OF DENDRITIC AND AXONAL PROCESSES

1st ethical directive developed after World War II to protect human subjects in research was called: (2x)

NUREMBERG CODE

In the individual component of DBT, a therapist spend time in:

NURTURING THE PT AND REQUIRING PT TO HELP HERSELF

18 month old shows a marked awareness of vulnerability to separation and seems to be constantly concerned about the mother's actual location is exhibiting Mahler's stage of?

OBJECT CONSTANCY

Final phase of Mahler's separation — ability to maintain positive emotional attachment in face of frustration

OBJECT CONSTANCY

Toddler soothed at night by inner memory of secure relationship with mother. Called what (in attachment theory):

OBJECT CONSTANCY

An infant who engages in an interactive game of peekEaEboo most closely demonstrates the concept of which cognitive ability? (2x)

OBJECT PERMANENCE

Infant who engages in an interactive game of peekEaEboo most closely demonstrates the concept of which of the following cognitive abilities?

OBJECT PERMANENCE

Early behaviorist theory promoted what

OBJECTIVE PSYCHOLOGICAL RESEARCH

According to both strategic and structural family therapies, which of the following is the underlying basis for analysis of symptoms and dysfunction in children, parents, and families?

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

According to strategic and structural family therapies - underlying basis for analysis of symptoms in children, parents, and families

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

23 y/o pt presents to ED by ambulance for SI. Pt has alcohol odor and slurred speech. He endorses SI but his plan is incomprehensible. Next step:

OBSERVE AND EVALUATE WHEN HE IS SOBER.

What is an important technique of structural family therapy?

OBSERVING THE RELATIVE INFLUENCE OF EACH FAMILY MEMBER ON THE OUTCOME OF AN ACTIVITY

Which of the following represents a disorder of the content of thought?

OBSESSIONS

9 y/o female bibEparents for outpt evaluation due to behavior difficulties at home. Reports daughter "explodes" when she doesn't get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states, "sometimes I just get mad." Which is the most appropriate initial diagnostic step?

OBTAIN A TEACHER REPORT

Screening blood test in a 72 yo pt admitted for behavioral outbursts, progressive cognitive decline and ataxia reveal a positive serum vdrl. Family members cannot eliminate the possibility that the pt was exposed to syphilis. The pt has had a history of allergic reaction to penicillin. Which of the following is the most appropriate next step?

OBTAIN CSF FOR FTEABS

Pt has phoned the ED complaining of hallucinations that command the pt to kill others. Psychiatrist's first action:

OBTAIN PHONE NUMBER, ADDRESS OF PATIENT

Bipolar pt on lithium and Zoloft for 3 yrs. Level 0.8. More depressed and fatigued, low energy level. Increasing Zoloft ineffective. Next step:

OBTAIN TSH LEVEL

Learning triangular relationships

OEDIPAL STAGE

Psychiatrist who does not normally take phone calls during therapy sessions has an emergency call put through 30 minutes into a 50 minute session with a pt. The psychiatrist apologizes, explains that it is an emergency that cannot wait, and asks the pt to sit in the waiting room until the call is finished, which turns out to be 15 mins. Next step:

OFFER TO RESCHEDULE THE PT'S SESSION, AND NOT CHARGE FOR THIS ONE THAT WAS INTERRUPTED.

Young pt in therapy returns to school, announces to therapist that he can pass classes, will graduate. Best response:

OFFERING CONGRATULATIONS

Which med has increased risk of hyperglycemia and DM?

OLANZAPINE

Rate of completed suicide highest for adult males when? (2x)

OLDER THAN 65

Psychiatrist conducting independent medical exam for individual's employer to determine fitness to return to work after med suspension due to supervisory complaints of erratic behavior/lapses in judgment. Despite having been informed that results of exam are not confidential/will result in report to employer, individual reveals being homosexual, but not having "come out." Best way to handle this?

OMIT MATERIAL UNLESS IT IS DIRECTLY RELATED TO THE REPORTED WORK PROBLEMS

The concept of the identified patient in therapy refers to:

ONE FAMILY MEMBER WHO HAS BEEN LABELED THE PROBLEM BY THE FAMILY

Behavioral frequency altered by application of positive and negative consequences (2x)

OPERANT CONDITIONING

In biofeedback, the autonomic nervous system can come under voluntary control through which of following mechanisms?

OPERANT CONDITIONING

Learning from consequences of one's actions (2x)

OPERANT CONDITIONING

Most ethical action when psychiatrist receives subpoena for records pertaining to patient arrested for selling marijuana

OPPOSE SUBPOENA DUE TO LACK OF PT CONSENT

Child argues with mom, is angry and rude. Has no trouble at school and completes schoolwork. Dx? (2x)

OPPOSITIONAL DEFIANT DISORDER

36 y/o F pt w/ schizophrenia has been treated w/ olanzapine is discovered prolactin level : 354ng/ml (normal:3E30).The first action is:

ORDER A PREGNANCY TEST

MetaEanalysis suggests which of the following for psychotherapy to treat depression?

OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT

Recent metaE analyses have suggested what with regard to the use of psychotherapy to treat depression?

OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT

What is a major therapeutic goal of selfchelp groups? (2x)

OVERCOMING MALADAPTIVE BEHAVIORS

Which is a major therapeutic goal of selfEhelp groups?

OVERCOMING MALADAPTIVE BEHAVIORS

Pt is often tardy. Supervisor warns not to be late. Pt has anxiety about losing job. When father dies he leaves town w/o telling supervisor. Again given warning. Next day a train causes him to be late. In therapy, the overlapping of multiple potential causes for tardiness is an example of what?

OVERDETERMINATION

A CBT therapist works with a therapist, amongst other things, to identify and correct:

OVERGENERALIZATION

Pt sadly reports receiving a college rejection letter, and then disparagingly predicts that all the other colleges applied to will reject him as well. This is an example of:

OVERGENERALIZATION AND ALLEORENONE THINKING

Beginning therapist feels great empathy for depressed pt fails to maintain sufficient distance to observe selfEdestructive patterns. To avoid this pay attention to:

OVERIDENTIFICATION WITH PATIENT

Shown to be critical to the development of maternalEinfant bonding in animals:

OXYTOCIN

What condition has been shown to increase the risk of suicide to the greatest degree in persons with depression?

PAIN SYNDROMES

The most common psychiatric symptom associated with pheochromocytoma?

PANIC ATTACKS

A couple in therapy for relationship difficulties that are related in part to one partner's frequent nagging of the other. The therapist recommends that the nagging partner intentionally nag the other partner three times a day, regardless of whether there is an urge to do so or not. This technique of prescribing the symptom is an example of:

PARADOXICAL INTENT

Therapy technique of prescribing a preEexisting sx behavior in relationship therapy

PARADOXICAL INTENT

Therapeutic technique where therapist instructs the patient to hold onto a symptom: (2x)

PARADOXICAL INTERVENTION

A disorder of content of thought

PARANOIA

Hypnosis would be contraindicated in the treatment of patients with:

PARANOIA

Purpose of DBT to diminish what?

PARASUICIDAL THOUGHTS

A 10 yo child presents with explosive outbursts at home when asked to complete tasks or when told no. These behaviors are not present while playing with siblings. Which of the following treatments has the largest body of evidence supporting its use to treat this condition?

PARENT MANAGEMENT TRAINING

Which of the following is the most effective evidenceEbased treatment of oppositional defiant disorder (ODD):

PARENT MANAGEMENT TRAINING

Which of the following principles is most commonly endorsed in parent management training programs for treatment of oppositional defiant disorder?

PARENTAL ATTENTION FOR PROSOCIAL BEHAVIOR

Most important protective factor determining preschool child's reaction to disaster (2x)

PARENTAL FUNCTIONING

The psychiatric assessment of a child or adolescent should always include: (2x)

PARENTAL INTERVIEW

Amantadine is considered effective in treating pts who have which side effects of antipsychotics?

PARKINSONISM

The SSRI most likely to cause discontinuation syndrome:

PAROXETINE

What med is most potent inhibitor of the norepinephrine transporter?

PAROXETINE

Which SSRI has mild anticholinergic activity due to some affinity at the muscarinic receptors? (3x)

PAROXETINE

Which SSRI has the greatest potential for discontinuation syndrome with missed doses?

PAROXETINE

Which of the following antidepressant meds is considered to be the most effective in the tx of premature ejaculation?

PAROXETINE

Effective for OCD

PAROXETINE, PHENELZINE, FLUVOXAMINE, CLOMIPRAMINE (NOT BUPROPION)

18 y/o M pt is brought to the ER w/ sudden onset of anxiety. Pt reports suddenly experiencing a pounding heartbeat, SOB, chest pain, and palpitations lasting 1hr. On exam pulse is 200 and blood pressure is 90/60. Pt is instructed to perform a Valsalva maneuver and he improves. Diagnosis? (2x)

PAROXYSMAL ATRIAL TACHYCARDIA

48 y/o with chronic sadness and no relationships since husband died 12 years ago. Normal grieving, no DSMEIV criteria for d/o, has successful career and close friends. States has conversations with her dead husband and he talks to her. Believes in heaven. Likely classification of these experiences is:

PART OF A BELIEF SYSTEM ENDORSED BY HER RELIGION

What type of reinforcement is most effective for maintaining behavior that is resistant to extinction?

PARTIAL

What unique binding property of Abilify (Aripiprazole) distinguishes it from other antipsychotics?

PARTIAL AGONIST ACTIVITY AT D2 RECEPTORS

Repeated presentation of a conditioned stimulus without being paired with its unconditioned stimulus will result in what?

PARTIAL REINFORCEMENT

Pt uses oral sex as sole source of sexual gratification, refusing coitus. Diagnosis?

PARTIALISM

According to APA, it is unethical for a psychiatrist to:

PARTICIPATE IN LEGALLY AUTHORIZED EXECUTION

Best predictor of future violent behavior is:

PAST VIOLENT BEHAVIOR

In determining the disclosure of psychiatric treatment information in court, which of the following individuals is considered to hold privilege:

PATIENT

What is a neologism?

PATIENT MAKES UP A WORD

Psychiatrist judges patient under managed care plan will need combined psychopharm and psychotherapy for > 1yr. Knows that health plan stops paying after 20 visits. Most ethical to tell patient:

PATIENT MAY NEED MORE TX THAN INSURANCE COVERS

Which factor most likely impedes cohesion in daily group therapy on locked adult general psychiatry units?

PATIENT TURNOVER

In cognitive therapy, "selective abstraction" is what?

PATIENT'S FOCUS ON A DETAIL TAKEN OUT OF CONTEXT AND CONCEPTUALIZES A EXPERIENCE BASED ON THIS ELEMENT

45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP - 65 wbcs (mostly lymphocytes), 78 protein, 63 glucose, + regain antibodies. Tx?

PCN

Unethical fee arrangement for forensic psychiatrist:

PERCENTAGE OF PLAINTIFF'S AWARD

What is an unethical fee arrangement for a forensic psychiatrist?

PERCENTAGE OF PLAINTIFFS AWARD

What task is useful in evaluating a pt's ability to concentrate?

PERFORMING SERIAL 7'S

7yo child w/ emotional outbursts at school and stomachaches, reluctance, and complaining at school time, but wellEbehaved at home, without stressors. Next step?

PERMISSION TO SPEAK WITH TEACHER

What symptom best differentiate chronic traumatic grief from uncomplicated bereavement?

PERSISTENT AVOIDANT OF DEATH REMINDERS

Not a diagnostic criteria for gender identity disorder:

PERSISTENT FANTASIES OF SEXUAL ACTIVITY WITH MEMBERS OF THE SAME SEX

According to Erikson, the predominant emotional issue in normal, schoolcaged children is: (2x)

PERSONAL WORTH AND COMPETENCE

8 y/o is evaluated due to problems at school. Child's vocabulary is normal and his conversation focuses on video games. He has social difficulties due to insisting on directing play w/ peers and being very controlling. He b/c agitated and disruptive when a substitute teacher is present and if there are even small changes in his daily routine. Dx?

PERVASIVE DEVELOPMENTAL DISORDER NOS

Risk factor most predictive of a pt having emergent SI:

PERVASIVE INSOMNIA

According to Freud, which psychosexual stage is associated with a primary erotic focus on the genital area and unconscious fantasies of sexual involvement with the oppositeE sex parent?

PHALLIC

Freud believed pt had fantasies of incest with oppositeEsex parents coupled with feelings of jealousy toward the sameEsex parent during which stage:

PHALLIC

In what developmental period does a child see he/she is a child of his/her parents & that parents have a relationship to each other not solely related to their roles as parents?

PHALLIC

Fluoxetine should NOT be prescribed with what? (2x)

PHENELZINE

What drug has been known to cause hypertensive crisis?

PHENELZINE

Who developed Moral Treatment?

PHILLIPE PINEL

Immanuel Kant contributed which development of psychiatry?

PHILOSOPHICAL FOUNDATIONS FOR CLINICAL ETHICS

The most common deficit underlying reading disorder in EnglishEspeaking children is deficit in:

PHONOLOGICAL FUNCTIONING

Sildenafil inhibits which enzyme?

PHOSPHODIESTERASE 5

40 y/o eats and sleeps too much, craves sweets, poor concentration, irritable, constant conflicts with husband. States "I always feel better in spring." What is the treatment?

PHOTOTHERAPY

Reluctance to discuss sex issues or take sex history:

PHYSICIAN'S OWN ANXIETY

Which of the following abnormal elevated metabolic findings has been associated with increased risk of stroke in pts under the age of 50?

PLASMA HOMOCYSTEINE

Two 4Eyr olds playing, one makes loud noise, the other does not want to play any more. Why?

PLAY PRODUCED EXCESSIVE ANXIETY FOR CHILD

According to Kohlberg, moral judgment made by older schoolEage children are based largely on which of the following?

PLEASING THOSE IN AUTHORITY

The number of individuals with a d/o at a specific time

POINT PREVALENCE

Social psychological study of the view of self in some western cultures has delineated differences from the definition of self in many nonEwestern cultures. What best describes the basis for positive selfEesteem in those nonEwestern cultures? (2x)

POSITIVE CONTRIBUTIONS TO THE GROUP AND HARMONIOUS RELATIONS

Homosexual couple w/ sexual dysfunction. Consider:

POSSIBILITY OF LINK BETWEEN PROBLEMS OF SUBSTANCE ABUSE & ACCEPTANCE OF SEXUAL ORIENTATION

Cartesian dualism from the theories of René Descartes refers to

POTENTIAL OF HUMAN NATURE FOR BOTH GOOD AND EVIL

Method for estimating sample size required to detect statistical effects of defined size for variables w wellEknown variances is referred to as which type of analysis?

POWER

What is the method for estimating sample size required to detect statistical effects of defined size for variables with wellEknown variances is referred to as which of the following types of analysis?

POWER

Which of the following characteristics is common to all brief dynamic psychotherapies?

PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION

4 y/o child that was hypotonic as an infant is now demonstrating developmental delays, foraging for food and having many temper tantrums. DX?

PRADEREWILLI SYNDROME

Firstcline treatment for restless leg syndrome (2x)

PRAMIPEXOLE

Pt able to recall his address after being prompted to do so. According to Sigmund Freud, this information is stored at what level of the topographic model?

PRECONSCIOUS

Pt w/ hx of EtOH dependence BIB wife, who states that pt's long term use of ETOH has resulted in marital separation and persistent unemployment. Pr refuses to stop drinking. Psych MD asks pt about his perspective regarding his use of ETOH, pt responds, "It may be a problem." Psych MD suggests Tx and pt says,"I will think about it." According to the stages of change model, which stage?

PRECONTEMPLATION

Ask a child, "What makes a train go?" He replies, "The smoke makes it go." This is:

PREEOPERATIONAL THINKING

At what developmental stage due kids first exhibit ability to recognize their thoughts and feelings are their own, and that others may think and feel differently?

PREESCHOOL AGE

The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with what neurobiological change?

PREFERENTIAL LOSS OF EXCITATORY SYNAPSES

The therapeutic effect of 2nd generation antipsychotics on negative symptoms of schizophrenia is thought to be related to the induction of expression in what area of the brain?

PREFRONTAL CORTEX

Transcranial magnetic stimulation for Tx of depression targets which brain regions?

PREFRONTAL CORTEX

According to neuroimaging studies of adol, the prefrontal cortex at this age:

PREFRONTAL CORTEX DEVELOPS LATER THAN OTHER AREAS OF BRAIN

Characteristic of women with increased risk of battery

PREGNANCY

Clinical circumstance that best warrants consideration of psychotherapy as the sole treatment for mild to moderate depression:

PREGNANCY, LACTATION, OR WISH TO BECOME PREGNANT

The prevalent male sexual d/o is:

PREMATURE EJACULATION

Animistic thinking is characteristic of which of Piaget's stages of cognitive development?

PREOPERATIONAL THOUGHT

To prove medical malpractice, the plaintiff must establish duty, dereliction, damages and direct causation by what part of proof

PREPONDERANCE OF EVIDENCE

Which of the following is a risk factor for child abuse?

PRESENCE OF A STEPEPARENT

Pt w/ severe depression is interviewed for enrollment in an experimental trial. Pt has failed multiple medications and several courses of ECT. The pt is competent but clearly distressed at the time of consent for treatment. Next step?

PRESENT INFORMATION SEVERAL TIMES USING DIFFERENT METHODS AND FEEDBACK TESTING

First pass effect refers to which of the following aspects of a med's metabolism? (2x)

PRESYSTEMIC ELIMINATION

Principal goal of wraparound services:

PREVENT HOSPITALIZATION OR RESIDENTIAL PLACEMENTS

Goal of wrapEaround services of C&A

PREVENT HOSPITALIZATION OR RESIDUAL PLACEMENT

What factors is most highly correlated with completed suicide in adolescent males?

PREVIOUS SUICIDE ATTEMPT

Reminding patients to get flu shots: type of prevention?

PRIMARY PREVENTION

65y/o w/ h/o asthma presents for treatment of essential tremor. Which for firstcline? (4x)

PRIMIDONE

Consistent predictor of future suicidal behavior (2x)

PRIOR ATTEMPTS

Risk factor influencing psychological outcome of child following death of parent: (2x)

PRIOR CONFLICTUAL RELATIONSHIP BETWEEN CHILD AND DECEASED PARENT

US Supreme Court Decision Washington v Harper 1990, the right to refuse treatment is limited for prison inmates because:

PRISON SECURITY CONCERNS OUTWEIGH INDIVIDUAL AUTONOMY INTERESTS

How do antipsychotic meds elevate prolactin (PRL)? (4x)

PRL IS UNDER TONIC INHIBITORY CONTROL BY DOPAMINE

Statistical concept of power is defined as the

PROBABILITY OF REJECTING NULL HYPOTHESIS WHEN IT SHOULD HAVE BEEN REJECTED

An attorney requests psychiatric consultation when his defendant wants the worst possible outcome from the trial because he feels he deserves the worst punishment possible. What direction should you take for this case?

PROBABLY MEETS CRITERIA FOR FINDING OF INCOMPETENCE TO PROCEED

A physician who is testifying as an expert in court is different from a regular or "fact" witness in that the expert is allowed to testify about which of the following?

PROFESSIONAL OPINIONS

AIDS and progressive hemiparesis and R homonymous visual field deficit assoc w patchy white matter lesions on MRI with normal routine CSF.

PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY

AIDS patient with memory problems, R hemiparesis, L limb ataxia, BL visual field deficits, and normal CSF. MRI T2 scan showed.

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

According to psychoanalytic theory, feelings of persecution are most reflective of which of the following defense mechanisms?

PROJECTION

When asked about a coworker after a recent conflict, a patient states "I harbor no ill feelings toward him, but he truly hates me." The is example of which defense mechanism?

PROJECTION

Which defense mechanism most relevant to etiology of delusional disorders (like paranoia) according to psychodynamic theory: (2x)

PROJECTION

A defense mechanism characterized by a self of object representation that is disavowed by placing it into someone else, and inducing the latter to unconsciously identify with the self/object representation: (4x)

PROJECTIVE IDENTIFICATION

One group member alternates between being the "scapegoat" for the group or the "spokesman" for the group. These events are a group version of what?

PROJECTIVE IDENTIFICATION

Blockade of dopamine receptors in tuberoinfundibular tracts results in breast enlargement, galactorrhea, impotence, and amenorrhea. Mechanism is increase of:

PROLACTIN

Antipsychotic drugs elevate prolactin due to what?

PROLACTIN IS UNDER TONIC INHIBITORY CONTROL BY DOPAMINE

Which of the following would be of most concern after initiating treatment with IV haldol for an 82 y/o pt with delirium?

PROLONGED QTC INTERVAL

LithiumEinduced tremor is usually reduced by which med?

PROPANOLOL

22 y/o pt suffers a traumatic brain injury following a skiing accident, and is admitted to an inpatient rehabilitation facility. There, pt has frequent episodes of sudden anger and aggression directed toward staff. On psychiatric evaluation, pt is aware of these episodes, saying, "I can't help it, I just see red." Pt denies symptoms of depression or anxiety, and there is no evidence of acute confusion on examination. The rehabilitation staff report that all behavioral strategies have failed, and that pt's outbursts are intimidating the staff. Which of the following medications has the best evidence for efficacy?

PROPRANOLOL

Lithium induced tremor is usually reduced by which of the following meds?

PROPRANOLOL

Which med reduces the acute symptoms of neurolepticEinduced akathisia?

PROPRANOLOL

Duty as outlined by Tarasoff

PROTECT THE POTENTIAL VICTIM OF A DANGEROUS PATIENT

Child has highEactivity motor level. Teacher should

PROVIDE BRIEF ERRANDS TO DO WHEN THE CHILD IS PARTICULARLY RESTLESS

18 y/o F in ED, just raped. Immediate intervention:

PROVIDE SUPPORT AND ALLOW TO VENT

The treatment goal of psychoeducation in multifamily group tx that is intended to assist family to cope w/ stresses of living w/ psychotic or severe mood d/o pt.

PROVIDING KNOWLEDGE AND DIRECTGUIDANCE

Social skills training for those with persistent mental illness is an essential part of:

PSYCHIATRIC REHABILITATION

A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the:

PSYCHIATRIST

Final legal responsibility falls on

PSYCHIATRIST

Patient with MDD; psychiatrist prescribes antidepressant, psychologist provides interpersonal therapy. Who is responsible & accountable for what? (2x)

PSYCHIATRIST IS RESPONSIBLE & ACCOUNTABLE FOR ALL TREATMENT; PSYCHOLOGIST JUST FOR PSYCHOTHERAPY

Psychiatrist agrees to prescribe medication to a pt who receives ongoing psychotherapy from another mental health professional. What is the psychiatrist's liability in this treatment arrangement?

PSYCHIATRIST RETAINS FULL RESPONSIBILITY FOR THE PATIENT'S CARE

Barrier to broader use of telepsychiatry

PSYCHIATRISTS HAVE BEEN RELUCTANT TO USE THIS MODE OF CARE PROVISION

Exploration of transference needed for reparative emotional experience psychotherapeutic treatment?

PSYCHOANALYTIC PSYCHOTHERAPY

Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict?

PSYCHODYNAMIC PSYCHOTHERAPY

Therapist is working w family of schizophrenic. Strategies include informing about illness, social support, management guidelines. Therapist encourages calm problem solving approach/facilitates stress and stigma reduction when possible. Which model is therapist using?

PSYCHOEDUCATIONAL

70 y/o presents with fearfulness, anger and agitation after moving in with adult child. On first visit pt is resigned and timid during exam. Which is most consistent with pt's behaviors?

PSYCHOLOGICAL ABUSE

Masturbation in adults as viewed by contemporary psychiatry is best described as:

PSYCHOPATHOLOGICAL ONLY IF IT IS COMPULSIVE

Masturbation in adults as viewed by contemporary psychiatry is best described as:

PSYCHOPATHOLOGICAL ONLY IF IT IS COMPULSIVE.

Pt has been sexually assaulted is in the ER immediately after the trauma. Initiation of which of the following is most likely to be helpful in preventing longcterm psychiatric sequelae? (2x)

PSYCHOSOCIAL INTERVENTIONS TO ESTABLISH SAFETY FROM FURTHER TRAUMA

Which is NOT common in patients >65: depression, cog d/o, phobias, ETOH d/o, psychotic d/o

PSYCHOTIC D/O

Pts w lateElife depression compared w early onset depression more likely to report:

PSYCHOTIC SXS

Which is the most significant disadvantage of using a family member as interpreter for a patient who does not speak the psychiatrist's language?

PT MAY CENSOR COMMENTS TO KEEP INFO FROM THE FAMILY

85 y/o pt w/ hx of HTN and COPD reports feeling depressed. The pt has an episode of depression 20 yrs ago, which was successfully treated with nortriptyline. The pt's HTN is currently well managed with hydrocholorothiazide. The physician prescribes nortriptyline 25mg qday. After 1 wk, the pt calls and reports feeling no better. What would be an appropriate reason to obtain a nortriptyline level?

PT'S ADVANCED AGE

Pt in ED for treatment of OD - was found 4 hrs ago after ingesting 10 cold med packs of 650mg Tylenol, antihistamine, and alpha 1 agonist decongestant. Pt is pale and vomiting. How do you decide whether to use NEacetylcysteine as an antidote?

PT'S SERUM NEACETYLEPEAMINOPHENOL (APAP) LEVEL OVER TIME

A mother gives an 8 y/o a "time out" for five min in the bedroom because of his misbehavior. This is an example of what behavioral technique?

PUNISHMENT

In learning theory, the presentation of an aversive stimulus that is contingent upon the occurrence of a particular response is known as:

PUNISHMENT

IPT of adults w/ depression begins w/assessment of pt's adjustment to stressful life events, role transitions and disputes, and:

QUALITY OF SOCIAL CONNECTIONS

Which of the following factors has the most evidence to support its protective effect in bereavement following the loss of a spouse?

QUALITY OF SOCIAL SUPPORT OF THE BEREAVED

Antipsychotic associated with development of cataracts

QUETIAPINE

Which of the following agents is most likely to be helpful in the treatment of visual hallucinations and psychosis associated with advanced Parkinson's disease?

QUETIAPINE

Family response to a member w ataque de nervios would most likely be to do what?

RALLY TO SUPPORT RELATIVE BY REMOVING STRESSORS

According to APA guidelines, what is the place of expert opinion in evidenceEbased medicine?

RANKS AS EVIDENCE COMPARABLE TO CASE STUDIES

Which of the following factors is a predictor of a poor response to lithium? (2x)

RAPID CYCLING

A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause EPS is based one which of the following properties of atypical antipsychotics?

RAPID DISSOCIATION FROM D2 RECEPTORS

Most likely to be enhanced by the strategies of putting the pt at ease, finding the pt's pain and expressing compassion, evaluation pt's insight, and showing expertise: (4x)

RAPPORT

What is most likely to be enhanced by strategies of putting the pt at ease, finding the pt's pain and expressing compassion, evaluating insight, and showing expertise?

RAPPORT

18 m/o is vulnerable to separation and constantly concerned about mother's actual location. This is representative of Mahler's stage of:

RAPPROCHEMENT

20Emonth child repeatedly returns to her mom when playing w/ other 2Ey/o children. This is:

RAPPROCHEMENT

A rating instrument is said to have high reliability when which of the following properties is demonstrated:

RATINGS ARE SIMILAR AMONG DIFFERENT RATERS.

Pt w/ severe GI disease requests a surgical procedure with questionable efficacy and a relatively high risk of negative effects. Level of competency a psychiatrist would require to find pt competent to make treatment decision?

RATIONAL CONSIDERATION OF ALTERNATIVES

Biofeedback usually helps pts with which syndrome?

RAYNAUD'S SYNDROME

Major psychological defense mechanism that determines the form and quality of OC symptom is

REACTION FORMATION

Patient with murderous impulses towards a neighbor gives the neighbor a bouquet of flowers. This is an example of:

REACTION FORMATION

3 y/o with diminished appetite, slow speech development, poor social interactions; parents are detached from him. After 2 weeks in hospital is improving and friendly with staff members. Dx?

REACTIVE ATTACHMENT D/O

5 y/o adopted at age 4 now hugging strangers, age appropriate vocabulary, doesn't respond well to limits, easily frustrated.

REACTIVE ATTACHMENT D/O

5 y/o child with behavioral problems in school, in and out of foster care for the first 2 years of life. Friendly and affectionate with others even with strangers. Parents don't feel "close" to the child and doesn't seem to have enduring friendships. Diagnosis:

REACTIVE ATTACHMENT DISORDER

The most common learning disability found in schoolEage children

READING DISORDER

What is most common learning/communication D/O in kids receiving special ed?

READING DISORDER

Psychiatrist wishes to assess a pt's premorbid intellectual functioning. Which of the following tests would be best for this purpose?

READING SUBSET OF THE WIDE RANGE ACHIEVEMENT TEST

7 y/o referred for psych eval due to learning probs. Most helpful info would be family's approach to and hx

READING WITH THE CHILD

4 months ago the wife of a pt died and pt blames himself for her death. Next step:

REASSURANCE

After mild MI 70 y/o seen by psychiatrist for depression. Seen for psychotherapy, given SSRI. Describes fear of imminent death. Psychiatrist tells him cardiologist is excellent, he is receiving best care. What illustrates supportive therapy:

REASSURANCE

A child's parents are very concerned that their 4 y/o son still wets himself several times a week. The child's brothers were potty trained when they were 3 and 3.5 years old. There is no evidence of developmental delay and the child's pediatrician has found nothing unusual. Which would be most appropriate intervention?

REASSURANCE AND MONITORING

7 monthEold is not crawling. Pediatrician is unconcerned. Child is alert, responsive, sits normally, shows good response to toys/stimuli. Psychiatrist should tell family:

REASSURANCE AND PROVIDE READING MATERIALS

What interventions are consistent w the theoretical assumptions of crisis Tx?

REASSURANCE, BRIEF HOSPITALIZATION, PSYCHODYNAMIC INSIGHT, TREAMENT WITH PSYCHOTROPIC MEDICATIONS (NOT FOCUSING ON PAST RELATIONSHIPS)

Most likely represents an acceptable boundary crossing by a therapist as opposed to a boundary violation: (2x)

RECEIVING COOKIES AS AN EXPRESSION OF GRATITUDE BY A PT NEAR TERMINATION.

24 yo pt comes to ed with wrist cuts. pt reports having no intention to die but wanted to feel things. Admits to other self harm behaviors when stressed. Admission to psych hospital would be most supported by what in the patients history?

RECENT ALCOHOL ABUSE

Greatest risk of death w/ ECT:

RECENT MI

If a response inhibitory to anxiety occurs in the presence of anxietyEevoking stimuli, it weakens the connection between the stimuli and the anxiety. This is called:

RECIPROCAL INHIBITION

Which event precipitates midlife crisis?

RECOGNITION OF UNATTAINABLE GOALS

According to Kohlberg's theory of moral development, a 9 y/o child would be expected to reach the decision that an action is wrong based on which of the following criteria:

RECOGNIZE ETHNIC AND RACIAL STEREOTYPES

As children progress through school age development, they begin to

RECOGNIZE ETHNIC AND RACIAL STEREOTYPES

The term rapprochement in Mahler's developmental theory refers to the:

RECONCILIATION FOLLOWING A BRIEF ATTACHMENT RUPTURE BETWEEN TODDLERS AND PARENTS

Most important guideline re: hypnosis

RECORD ON VIDEOTAPE

Most common time for pt w/ schizophrenia to attempt suicide is during

RECOVERY PHASE OF THE ILLNESS

57 y/o pt w/ hx of bipolar disorder has been stable on lithium for 10 years, with average level of 0.8mEq/L. Pt now presents to ER c/o feeling nauseous. Pt is noticed to be tremulous and to have an unstable gait. She was recently prescribed a medication for HTN. Lithium level is found to be 1.5mEq/L. It is assumed that this increased level is due to an interaction between the lithium and the new medication. What is the most likely mechanism for this interaction?

REDUCED RENAL CLEARANCE

A pt who was previously stable on Lithium presents with symptoms of toxicity after their PMD starts them on a HTN medicine. Which of the following is the is the most likely mechanism of interaction between the lithium and the HTN medication?

REDUCED RENAL CLEARANCE

26EyearEold female with intense burning pain with intercourse for several weeks causing her to tense up during penetration. Most appropriate action?

REFER FOR COMPREHENSIVE GYN EXAM

A 45 yo man believes he has gastric cancer, and reports indigestion and reflux. The patient finds himself so distressed with this thought that he has been having problems at home and at work. Which of the following would be the most reasonable strategy for a psychiatrist to consider when treating this patient?

REFER FOR FURTHER MEDICAL EVALUATION

M pt BIB to ED by police after he threatening to kill his wife and admits that has thoughts of harming his spouse ever since learning of her infidelity, saying "I want her to hurt like I do now." The pt doesn't display delusions and mood problems. He admits to drinking occasionally, but in the last week and prior to violence. Next step:

REFER PT BACK TO LAW ENFORCEMENT

College student in therapy, the Dean calls therapist requesting info about the student's therapy due to recent reports from a dorm supervisor. Therapist should:

REFUSE THE DEAN'S REQUEST FOR INFORMATION

Defense mechanism: a transient return to earlier behaviors characteristic of earlier stage of development in response to stress/conflict, despite overall maturation (2x)

REGRESSION

A method for making a prediction based on observable data in order to assess the valve of the one variable in relation to another is

REGRESSION ANALYSIS

What statistical measure should be used to determine how 2 independent variables affect the frequency of the occurrence rate of an event?

REGRESSION ANALYSIS

What is a symptom of normal bereavement in a <5 y/o child after the death of a parent?

REGRESSION IN BOWEL AND BLADDER CONTROL

Supportive therapy differs from psychoanalytic therapy in that the therapist who is conducting supportive therapy does what?

REINFORCES EGO DEFENSES

During the initial interview of a couple presenting for therapy it is helpful to point out that the focus of therapy is primarily on the:

RELATIONSHIP PROBLEM

The potency of medication refers to which of the following properties of a medication?

RELATIVE DOSE REQUIRED TO ACHIEVE A CERTAIN EFFEC

The therapeutic index of a drug refers to the:

RELATIVE MEASURE OF DOSING TOXICITY TO SAFETY

Findings can be replicated

RELIABILITY

What DSMEIV diagnosis is likely for 41 y/o man with increasing sense of conflict about changing his beliefs from workEoriented to faithEoriented. No past or present psych symptoms, stable vocational hx.

RELIGIOUS AND SPIRITUAL PROBLEM

47 y/o F w/ increased preoccupation with questioning her lifelong affiliation with her church and has been spending time visiting other churches. Concerned she is losing her faith, feels guilty and anxious. No SI, MSE normal, states would never act against her moral beliefs. Dx? (3x)

RELIGIOUS OR SPIRITUAL PROBLEM

Preventing adolescent suicide:

REMOVE FIREARMS

What is primary role of psychiatric expert witness (4x)

RENDER OPINION BASED ON SCIENTIFIC KNOWLEDGE

Which of the following is the major negative aspect of crossover designs for research studies? (2x)

RESIDUAL EFFECTS

A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say, which is an example of: (2x)

RESISTANCE

Pt enters psychotherapy because of problems in his relationship with his wife. During the sessions, pt talks about his family of origin, his boss, and his problems at work, but never discusses details about his wife. This is an example of which of the following?

RESISTANCE

Pt repeatedly redirecting discussion by talking about irrelevant topics is example of:

RESISTANCE

Redirecting discussion by talking about irrelevant stuff

RESISTANCE

As part of comprehensive pain management team for pt w hx of narcotic abuse, a consulting psychiatrist may appropriately be asked to do which of the following? (2x)

RESOLVE CONFLICTS BETWEEN THE PATIENT AND THE TREATMENT TEAM

41 yo drunk male who is stuporous has a pulse of 75 and BP of 110/70. What is the most immediate clinical concern?

RESPIRATORY FAILURE

During last session of successful psychodynamic psychotherapy, pt warmly expresses gratitude for everything, saying that the help the therapist has given has made a big difference. Appropriate response?

RESPOND BY SAYING YOU TOO HAVE ENJOYED THE WORK

24 y/o F in 2nd trimester now manic w/ no psychotic fx's. Hx of 1 episode of mania, diagnosed bipolar I. D/C lithium when she decided to have kids. Willing to begin Tx.

RESTART LITHIUM

In helping a victim of rape in the ED, the first intervention?

RESTORE A SENSE OF SAFETY WITH THE PATIENT

55 y/o psychiatrically hospitalized pt with chronic schizophrenia stabilized on Clozapine. Two weeks after d/c pt p/w impending signs of psychotic relapse. Assuming pt adherence to meds and negative serum/urine tox screens, what is most likely explanation for relapse?

RESUMPTION OF HEAVY SMOKING

4 y/o girl developed normally in the 1st 18 months of life, but afterwards developed decelerated head growth, loss of purposeful hand movements, midline upper extremity stereotypies (e.g. handEwringing), severe psychomotor retardation and social withdrawal:

RETT DISORDER

12 y/o F not attending school for fear her mom may die in accident. Management?

RETURNING THE GIRL TO HER CURRENT CLASSROOM

Which ego defense is seen when an adolescent belittles parents in order to defend against regressive pull toward childhood?

REVERSAL OF AFFECT

13 y/o male tells psych MD "I'm tired of being the shortest boy in my class." Pt reports many of the girls are taller than he is. Both of the parents are tall. What is the most appropriate initial approach for the psychiatrist to take?

REVIEW WITH THE PT THE TYPICAL COURSE OF PUBERTY IN MALES

The Tuskegee syphilis study violated current ethical principles of research in the selection of participants and ...

RISK:BENEFIT RATIO FOR PARTICIPATING IN THE STUDY

Which antipsychotic med has the largest number of studies supporting its use for Tx of explosiveness and reactive anger in youth?

RISPERIDONE

CultureEbound syndrome in Caribbean and states bordering Gulf of Mexico - anxiety, GI distress, weakness, fear of being poisoned, attributed to witchcraft

ROOTWORK

This is considered as an unstructured psychological test:

RORSCHACH INKBLOT

What psych tests would be considered the most unstructured?

RORSCHACH INKBLOT

Which tests can be used for projective personality testing?

RORSCHACH, DRAW A PERSON, THEMATIC APPERCEPTION (NOT MMPI)

Winnicott defined his concept of holding environment as the:

SAFE CONTEXT PROVIDED BY CONSISTENT AND RELIABLE PARENTING

When used as a tx following a traumatic event, hypnosis has been found to:

SAFELY DECREASE PAIN AND STRESS IN THOSE WHO ARE HYPNOTIZABLE

Check fasting lipid panels before starting treatment before atypical antipsychotics. Which health quality implemented according to the aims of the Institute of Medicine?

SAFETY

Therapeutic index is a relative measure of which of the following characteristics of a medication?

SAFETY

Psych comorbidities in individuals w mental retardation vs general population:

SAME TYPES OF PSYCHOPATHOLOGY

IgG elevated in CSF and serum is most consistent with which illness?

SARCOIDOSIS

Which of the following statements specifically tests concentration?

SAY THE LETTERS OF THE ALPHABET BACKWARDS STARTING WITH "Z"

C&L psych sees 58 y/o widowed pt medicine wants to discharge d/t neg workup for abd pain and nausea. Pt refuses to return home to adult kids because the food they prepare are making her sick and causing her sxs. MSE unremarkable and no past psych hx. Next step?

SCHEDULE MEETING WITH THE MEDICAL TEAM, PATIENT, AND FAMILY

Psych eval of 82 y/o F with memory loss (mostly working memory): she frequently calls for help with bathroom but will urinate on herself (staff feel pt is doing this to get back at them). Pt frustrated with staff because she feels the sudden need to void without much warning and wishes the staff would arrive sooner because she's embarrassed about this. MSE significant only for mod memory loss, labs are normal. Which behavioral intervention should be attempted with pt?

SCHEDULE REGULAR VOIDING, INDEPENDENT OF PT REQUESTS, AND SUFFICIENTLY FREQUENT TO ELIMINATE THE ACCIDENTS

Adol pts with velcardiofacial syndrome (chromosome 22q11 deletion syndrome) are at substantially increased risk for developing which psychotic d/o?

SCHIZOPHRENIA

American psychiatrists over dx in African American patients w mood/psychotic sx?

SCHIZOPHRENIA

Retrospective interviews with homosexual adults have established that, for the majority, their sexual orientation was selfErecognized at what age?

SCHOOL AGE

What is an example of secondary prevention?

SCREENING FOR DEPRESSION.

When DBT is used to treat patients with borderline, the word dialectical refers to treatment strategies that focus on: (2x)

SEARCHING FOR A SYNTHESIS BETWEEN SEEMINGLY CONTRADICTORY IDEAS

What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about effectiveness of 2nd gen. antipsychotics for tx of schizophrenia?

SECOND GEN. ANTIPSYCHOTICS WERE NO MORE EFFECTIVE THAN FIRST GENERATIONS

The "strange situation" in child development is used to assess the infant's in attachment theory: (2x)

SECURITY OF ATTACHMENT

Most common side effect with clozapine tx is

SEDATION

After attending several sessions of individual psychotherapy for anxiety and depression, 24 y/o M revealed his homosexuality to his heterosexual male psychiatrist. Therapist realizes he is uncomfortable when pt expresses longings for a male. Therapist also tends to overemphasize any material that might represent pt's heterosexual wishes. The next best step for the psychiatrist would be to:

SEEK CONSULTATION TO DISCUSS COUNTERTRANSFERENCE ISSUES

F pt in twicecweekly psychodynamic psychotx w male therapist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels flattered by the sexual interest of this patient and notes his own feelings of attraction to her. The most appropriate next step for the therapist is to: (3x)

SEEK CONSULTATION WITH A COLLEAGUE

Following a brief separation from the parents, a securely attached toddler is most likely to do which of the following:

SEEK CONTACT EAGERLY

A slow titration of Clozapine is required to decrease the risk of:

SEIZURES

Combined use of Lithium and SSRI is known to increase the risk of which of the following conditions?

SEIZURES

What is a major side effect of clozapine?

SEIZURES

As opposed to longcterm psychotherapy, timeclimited therapy more likely to: (2x)

SELECT CENTRAL ISSUE AS FOCUS

Cognitive error: when asked about his day, pt replies, "I was late for work b/c I misplaced my keys" then, "I didn't speak up in the staff mtg."

SELECTIVE ABSTRACTION

Pt with depression recounts to the psychiatrist events of the last week and descries many unpleasant experiences, concerns about the sadness of some friends, and a reluctance to read the newspaper because "all the news is bad." In cognitive psychology, which of the following formulations best accounts for this patient's presentation?

SELECTIVE ATTENTION BIAS

What inhibitor of monoamine oxidase is also useful in the treatment of Parkinson's disease?

SELEGILINE

Which med is irreversible MAOEB inhibitor?

SELEGILINE

The fundamental developmental need of all persons for mirroring, validation, and affirmation is central to which psychoanalytic theory?

SELF PSYCHOLOGY

What term describes the role that others perform for the individual in regard to mirroring, idealizing, and twinship needs?

SELFEOBJECT

9 yo f bibEparents for outpt evaluation due to behavior difficulties at home. Port daughter "explodes" when she doesn't get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states "sometimes I just get mad." What is the most appropriate level of care?

SEND THE PT HOME WITH PARENTS

Psychiatrist is treating 23 yo F w life long inability to maintain adequate lubricationE swelling response of sexual excitement until completion of intercourse. Pt on no meds, doesn't use drugs/EtOH, has no other med conditions. Most effective tx?

SENSATE FOCUS EXERCISE

A statistical term that refers to the proportion of pts with the condition in question that a test accurately detects:

SENSITIVITY

A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a subcthreshold stimulus, refers to: (2x)

SENSITIZATION

Form of learned fear in which a person or an animal learns to respond more strongly to an otherwise innocuous stimulus is:

SENSITIZATION

7 y/o with temper tantrums, refuses to go to school. Stomachaches and headaches on school days. Nightmares about being kidnapped, fears parents will die. Dx? (4x)

SEPARATION ANXIETY D/O

Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor

SEROTONERGIC 5HT2 ANTAGONISM

Trazodone requires larger doses to be used as an antidepressant due to lower potency affinity to which receptor?

SEROTONIC TRANSPORTER

MDD patient with good response to venlafaxine presents with dysphoria, agitation, nausea, poor balance after running out of medication. Cause of sx?

SEROTONIN DISCONTINUATION SYNDROME

27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5c hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks, diaphoretic, flushing, restless: (6x)

SEROTONIN SYNDROME

Patient comes to ED confused, lethargic, flushing, diaphoretic, and restless. Recently started fluoxetine but doesn't recall names of other psychotropics he's taking. Temp is 101.5, BP 110/62, has tremor and myoclonus. What's causing his symptoms?

SEROTONIN SYNDROME

Restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, and confusion are compatible with which diagnosis?

SEROTONIN SYNDROME

The temperamental trait of harm avoidance is associated with polymorphisms on which candidate genes?

SEROTONIN TRANSPORTER

50 y/o fireman became clinically depressed after sustaining a myocardial infarction. Most appropriate medication to prescribe:

SERTRALINE

Adol attends a "pharm party", takes 2 methadone tabs, later found to have decreased respirations and is rushed to the ED. Which med could cause an interaction which could cause this response?

SERTRALINE

Pt is admitted to the hospital for renal transplant rejection. Prior to this, the pt had been doing well since the transplant one year ago the pt reports compliance with the immunosuppressive regimen, but blood levels of cyclosporine are low; previously, the cyclosporine levels were within the therapeutic range. The pt reports recently starting on a pill to treat depression and anxiety, but denies any other medication changes or new health conditions. Which is the pt most likely taking?

SERTRALINE/NORTRIPTYLINE/VALIRANA OFFICINALIS/SE ADENOSINYLMETHINONINE (ALL OF THE ABOVE)

30 y/o in therapy struggles with feelings of ambivalence about mom. Mom now has metastatic BrCA. If the patient uses anticipation as a defense mechanism, she might:

SET ASIDE A NIGHT OF THE WEEK TO HAVE DINNER WITH MOM TO DISCUSS MOM'S RXN TO DIAGNOSIS

In terminal cancer patients who ultimately die by suicide, which one of the following complaints is most frequently reported?

SEVERE UNCONTROLLED PAIN

A 75 y/o man and his 72 y/o wife present requesting marital therapy. They describe increasing conflict beginning about a decade ago when the wife began refusing sexual activity. Husband explains that he still desires an intimate relationship and is frustrated and hurt. The wife explains that after menopause she could not understand her husband's desire. She suggests he find "some younger woman." He is insulted because he does not want to stray from marriage. The initial treatment approach should focus on:

SEX EDUCATION

Pt dissatisfied w marriage, no sex in a year despite husband's efforts, whenever husband tries to kiss her she becomes disgusted, uncomfortable, anxious. Avoids sex by neglecting personal hygiene. Inability to become aroused by husband which was ok in the past, masturbates to orgasm. Dx? (2x)

SEXUAL AVERSION DISORDER

The pattern of a person's biological sexual characteristics is known as:

SEXUAL IDENTITY

As conceptualized by selfEpsychology, which of the following is the most problematic reaction a patient can have when attempting to fulfill a selfEobject need?

SHAME

The operant procedure in which a desirable behavior pattern is learned by the successive reinforcement of approximations to that behavior is called:

SHAPING

Which of the following familial effects falsely inflates estimates of heritability?

SHARED DEVELOPMENTAL ENVIRONMENT

66 y/o sent threatening letters to the president, thinks CIA is following him. Wife similar convictions, dependent on husband, passive

SHARED PSYCHOTIC DISORDER

30 y/o pt recently Dx w/ Hodgkin's dz constantly states, "Why me?" According to Elizabeth KublerERoss, the patient's reaction is consistent with what phases?

SHOCK AND DENIAL

In the US, what is the most common method of completed suicide?

SHOOTING ONESELF

What characterizes the nature of boundary crossings in doctorEpt relationship?

SHOULD BE ASSESSED ACCORDING TO CLINICAL SITUATION

APA rule re: psychiatrist dating sibling of current pt

SHOULD BE AVOIDED WITH ANY 3RD PARTY

Guardian of a pt with MR with medicationErefractory epilepsy insists that the pt should have epilepsy surgery. Neurosurgeon believes the seizure focus can be resected, but there's a >50% chance of RUE paralysis which outweighs potential benefit from freedom from seizures. Guardian insists on surgery. Which describes physician responsibility in this case?

SHOULD PERFORM THE SURGERY ONLY UNDER COURT ORDER

What characterizes executive abilities in healthy individuals >65?

SHOW NO SIGNIFICANT CHANGE

A preschooler misses his longEterm nanny who has recently moved away. To help this child, the parents should: (2x)

SHOW THE CHILD PICTURES OF THE NANNY

19yo pt at ed w/ loss of vision w/o other syx. H/o severe recurrent abd pain. 1y ago pt had episode of l hemiparesis. In recent wks pt had episodes of transient visual blurring/loss spontaneously resolved. Physical shows bl cortical blindness, mild pronation of lue, mild bl spasticity, hyperreflexia, extensor plantar responses bl. No sensory changes. Dx? (cerebral angio and mri images not included)

SICKLE CELL DISEASE

Most likely to increase risk of impairment after bereavement in 80 y/o

SIGNIF DEPRESSIVE SXS SHORTLY AFTER THE LOSS

65 y/o pt w MDD c/o anorgasmia after starting tx w fluoxetine. How to tx?

SILDENAFIL

65 y/o M w impotence, diabetes, AFib. Psychiatrist recommends sildenafil. What do you tell the pt? 1) impotence is due to DM. 2) erectile dysfunction parallels diabetic complications. 3) sildenafil works for majority of patients w DM.

SILDENAFIL WORKS FOR THE MAJORITY OF PATIENTS WITH DIABETES.

In the structural model of family therapy, the family is viewed as a:

SINGLE, INTERRELATED SYSTEM WITH AN EMPHASIS ON BOUNDARIES BETWEEN THE GENERATIONS.

Which of the following effects is the basis for dantrolene's efficacy in the treatment of neuroleptic malignant syndrome (aka nms)?

SKELETAL MUSCLE RELAXANT

Melatonin agonists are useful in treating which type of sleep disorder?

SLEEP PHASE DELAY

75 y/o pt has developed tolerance to clonazepam over many years, now taking 5mg clonazepam at night but still with poor sleep. Pt denies any mood or anxiety symptoms, no drug problems. Next step:

SLOWLY WITHDRAW THE PT'S CLONAZEPAM AND REEVALUATE

2 y/o clings to mother when introduced to a new child, refusing to join in play during 1st visit. On 2nd visit, child plays behind mother, and on 3rd visit, she seems to continue her usual activities while warily eyeing the new child. What temperamental traits or constellations best describes this child's behavior? (2x)

SLOWcTOcWARMcUP

A patient has a seizure secondary to a supratheraputic level of clozapine. What changes in a patient's live could account for this finding?

SMOKING CESSATION

Imitating one's valued mentor while performing psychotherapy is an example of what type of learning?

SOCIAL LEARNING

3 y/o approaches a crossing street, looks at mother's expression to decide if it is safe to cross. This is an example of: (2X)

SOCIAL REFERENCING

After a stranger says "hello," a 12EmonthEold child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger:

SOCIAL REFERENCING

Pt w/ mild MR in program designed to develop new behaviors by modeling/ reinforcement, then practice them.

SOCIAL SKILLS TRAINING

Maturation of basal ganglia/cortical motor circuits is most closely assoc w development of:

SOCIAL SMILE

What most accurately describes scientific understanding of the concept of race?

SOCIOPOLITICAL DESIGNATION ASSIGNING INDIVIDUALS TO A PARTICULAR GROUP THAT HAS MEANING DERIVED FROM PREVAILING SOCIETAL ATTITUDES

Most commonly used cognitive therapy technique to uncover & modify automatic negative thoughts

SOCRATIC QUESTIONING

When compared to adol, 8c12 y/o children with depression most often show which symptom? (2x)

SOMATIC COMPLAINTS

In a session, a couple seems blissfully content when happy but enraged when frustrated by the other. They alternate between overidealizing and devaluing the other. This is an example of?

SPLITTING

25 y/o M w/ premature ejaculation refuses meds. Tx?

SQUEEZE TECHNIQUE

SE of toxic serum lithium levels

ST DEPRESSION, QTC PROLONGATION, ATAXIA, TREMOR, DYSARTHRIA, NEPHROTOXIC SX, STATUS EPILEPTICUS

Which best defines goals of supportive psychotherapy? (2x)

STABILIZE PT'S FUNCTIONING, STRENGTHEN PT DEFENSES

What is the most significant challenge to the clinical application of the analytic theory of libidinal stage development? (2x)

STAGES ARE MORE FLUID AND LESS STRICTLY SEQUENTIAL THAN THE THEORY SUGGESTS

What terms best defines the degree of spread of scores about the mean?

STANDARD DEVIATION

Test to assess intelligence in 4 y/o?

STANFORDEBINET

50yo referred to psych following negative medical workup of abd pain. Pt appears depressed and in constant pain. What is the preferred psych intervention?

START LOW DOSE IMIPRAMINE

Psychiatrist plans to add nortriptyline as adjunct to fluoxetine. He should proceed how?

START NORTRIPTYLINE AT LOWER THAN NORMAL DOSE

A resident is asked by his program to take a leave of absence due to erratic behavior and must undergo a psychiatric evaluation before returning. What statement best describes the obligation of the examining psychiatric MD?

STATE CLEARLY TO PT PRIOR TO EVALUATION THE PURPOSE OF THE EVALUATION AND THAT THE INFORMATION MAY BE TRANSMITTED TO RESIDENCY PROGRAM.

An internal medicine resident who is asked by the residency program to take a leave of absence due to erractic behavior must undergo a psychiatric assessment before returning to clinical duties. Which of the following statements best describes the obligation of the examining psychiatrist?

STATE CLEARLY TO PT PRIOR TO EVALUATION THE PURPOSE OF THE EVALUATION AND THAT THE INFORMATION MAY BE TRANSMITTED TO THE RESIDENCY PROGRAM

Who monitors physicians with substance abuse issues?

STATE MEDICAL BOARD AND STATE PHYSICIAN HEALTH PROGRAMS

In evaluating the sanity of a criminal defendant, the forensic psychiatrist should focus on current state of mind, or state of mind at time of offense?

STATE OF MIND AT TIME OF OFFENSE

A medical student takes amphetamines to stay awake while studying for an exam. When she takes the exam without any medication, she finds that she has much greater difficulty than usual remembering the material. What is this an example of?

STATEEDEPENDENT LEARNING

The group therapist notices that participants in a psychotherapy group experience selfE disclosure. Which stage of group development does this demonstrate?

STORMING

A 4 yo has developed what language skills?

STORYETELLING USING WORDS

What type of family therapy uses paradoxical directives, such as prescribing the symptom or behavioral sequence?

STRATEGIC

The factor most consistently associated with therapy outcome in psychotherapy research: (2x)

STRENGTH OF THERAPEUTIC ALLIANCE

What factor may be protective in assessing a pt's risk for suicide?

STRICT RELIGIOUS FAITH

Contraindication to family therapy

STRONG RELIGIOUS OR CULTURE BELIEFS AGAINST OUTSIDE INTERVENTION

Name of test where pt is told to name the colors in which the words are printed rather than reading the words themselves

STROOP COLOR WORD TEST

What neuropsych test relies on inhibition of the over learned behaviors to assess executive functioning?

STROOP COLOR WORD TEST

Which test assesses ability to attend to a task while inhibiting interfering stimuli?

STROOP COLOR WORD TEST

In what type of family therapy are the concepts of family hierarchies, boundaries, coalitions, and alliances seen as core concepts?

STRUCTURAL

Per psychoanalytic theory, unacceptable affects and impulses are commonly gratified in socially acceptable ways through:

SUBLIMATION

Absolute contraindication to sildenafil

SUBLINGUAL NITROGLYCERIN

25 y/o presents to ED c/o chest pain, SOB, and anxiety but appears NAD and calmly answers questions. Pt reports h/o panic attacks, requesting alprazolam by name, and reports "I usually need a prescription for at least 2mg 4x per day to get relief". When asked to describe 1st panic attack, pt states, "I can't remember when they started or the frequency". Which d/o is likely present?

SUBSTANCE ABUSE

Condition held to strictest legal confidentiality standard?

SUBSTANCE ABUSE

Along w/ depression most common comorbid disorder in physician suicide is

SUBSTANCE DEPENDENCE

One of the most common psych d/o found in individuals who commit violence against others (even more than IED, BMD, MDD, CPS):

SUBSTANCE RELATED D/O

Psych d/o in violent people

SUBSTANCE RELATED D/O

Which of the following is the most common psychiatric diagnosis associated with violent acts?

SUBSTANCE USE DISORDERS

21 y/o pt experiences a brief manic episode after starting an SSRI. The pt meets Dx criteria for what disorder? (2x)

SUBSTANCEcINDUCED MOOD DISORDER

Criterion for a covered disability under Americans with Disabilities Act:

SUBSTANTIALLY LIMITS ONE OR MORE MAJOR LIFE ACTIVITIES

Why is there limited value of serial sevens as a test of concentration?

SUCCESSFUL PERFORMANCE REQUIRES ARITHMETIC SKILL

38 y/o pt in dynamic psychotherapy for depression says she is lesbian and is dissatisfied with her otherwise good relationship with her partner of 7 yrs b/c she wants a child and her partner does not. She thinks about leaving the relationship but this makes her feel sadness and a sense of loss. What is best intervention?

SUGGEST THAT CONJOINT THERAPY WITH THE PATIENT AND HER PARTNER MIGHT BE A PRODUCTIVE WAY TO EXPLORE THIS COMPLICATED ISSUE

Black box warning on SSRIs with regard to children and adolescents:

SUICIDAL IDEATION

What psychiatric symptom does not require pharmacologic treatment in the ER?

SUICIDALITY

The leading cause of death among gun buyers in the first year after the weapon was purchased is:

SUICIDE

Lawsuits against psychiatrist most frequently arise from issues concerning:

SUICIDE ATTEMPTS

During a clinical interview, the physician recapitulates what the pt has said so far and says to pt "I just want to make sure that I've got everything right up to this point". This is an example of:

SUMMATION

Familial amyotrophic lateral sclerosis gene mutation:

SUPEROXIDE DISMUTASE (SOD)

24 y/o pt w tetraplegia after MVA showing no signs of grief or acknowledgement of poor prognosis, no significant depressive/anxious Sx. What psych intervention preferred? What psychotherapeutic school of thought emphasizes how a pt has managed feelings of envy/rage w particular emphasis on defense mechanisms?

SUPPORT BUT DO NOT CONFRONT THE PT ABOUT THE MEDICAL REALITIES EGO PSYCHOLOGY

Management of patient in denial immediately after MI:

SUPPORTING THE PATIENT, UNLESS DENIAL INTERFERES WITH CARE

Which psychotherapy would therapist be inclined to gratify pts' dependency needs?

SUPPORTIVE

What reflects opinion of APA on practice of charging a pt for a missed appointment (2x)

SUPPORTS IT IF IT IS CONTRACTED WITH THE PATIENT

A parent who just learned that her child has been injured and taken to the hospital, arranges for a neighbor to care for her other children and then rushed to the hospital. What defense mechanism did the parent use to handle her own fear? (2x)

SUPPRESSION

Semiconsciously diverting attention from a conflict in order to minimize discomfort is an example of what defense mechanism? (3x)

SUPPRESSION

Child holds toy telephone to face and speaks to Daddy. This behavior is called?

SYMBOLIC REPRESENTATION

A finding that should raise a concern for child abuse?

SYMMETRICAL BRUISING IN A 24EMONTHEOLD

Which of the following is the best test for general assessment of a patient's psychiatric symptom patterns?

SYMPTOM CHECKLISTE90EREVISED (sclE90)

Pt with which medical condition most likely to commit suicide?

SYMPTOMATIC HIV INFECTION

77. 7yo M w agression was referred by school for eval after IQ of 68 discovered. Pt was temperamentally inhibited and avoidant as an infant, difficulty interacting w peers and preoccupation with trains at age 2. No stereotypes or tic. Which aspeect of this presentation is most indicative of autism spectrum disorder?

SYMPTOMS PRESENT BEFORE AGE 3

Infectious neuropsychiatric d/o, characterized by psychosis and abnormal gait, that was once treated with malariaEinduced fever and accounted for up 20% of pts in mental asylums until 1940s:

SYPHILIS

Behavioral therapy w relaxation training/hierarchy construction/visual imagery?

SYSTEMATIC DESENSITIZATION

The behavioral therapy technique in which a pt is exposed to progressively greater fear inducing situations is referred to as:

SYSTEMATIC DESENSITIZATION

With the use of 2nd gen antipsychotics, alpha receptor antagonism is associated with what side effects?

TACHYCARDIEA

Therapist preoccupied w/ patient. Acknowledges this but unable to shake feeling

TALK TO SUPERVISOR

When psychiatrist asks about mania, pt responds, "that sounds exactly like my cousin," and proceeds to tell long story about cousin but doesn't answer the psychiatrist's request. This is an example of:

TANGENTIALITY

Worsening temper tantrums in 3 y/o. First occurred in grocery store and child was quieted with candy. The tantrums would occur at home and would escalate until given candy. Psychiatrist tells parents not to give candy during a tantrum under any circumstances. Outcome?

TANTRUMS WILL INCREASE THEN DECREASE

22 y/o brought to ED by roommate who found him unconscious with a suicide note. Temp 100.9, BP 100/60, P 124, RR 8, warm and dry skin, dilated pupils and reactive to light, bowel sounds decreased, EKG with sinus tachy and QTC of 589, no obvious trauma. On which did pt OD?

TCA

Which of the following is the principal service provided by the liaison component of consultationEliaison psychiatry?

TEACHING PSYCOSOCIAL ASPECTS OF MEDICAL CARE TO OTHER HEALTHCARE WORKERS

DBT is unique among commonly employed psychotherapy in encouraging judicious use by pts by which?

TELEPHONE CONSULTATION

Psychiatrist provides psychotherapy to 22 y/o pt who lives w/ parents and dx w/ anxiety and depression. Pt reports the father threw 13 y/o sibling across the room. Sib was not injured. Multiple similar episodes. What is appropriate response for the psychiatrist?

TELL PT THAT THE PSYCHIATRIST MUST REPORT THE ABUSE TO CHILD PROTECTIVE SERVICES.

Adult male presents to clinic with broken hand due to first time DV toward his sameEage spouse. Best response by psychiatrist?

TELL THE PATIENT THAT VIOLENCE IS HIS RESPONSIBILITY AND HE NEEDS TO STOP IT

75 y/o pt with cirrhosis should be given which of the following meds:

TEMAZEPAM

Activity level, regularity, approachEwithdrawal to new situations, adaptability, persistence are examples of:

TEMPERAMENTAL VARIABLES

Exclude a patient from a weekly outpatient group treatment group if:

TENDENCY TO ASSUME DEVIANT ROLE

Onset of puberty in boys begins with:

TESTICULAR ENLARGEMENT

Differentiation stage of group development is best characterized by what dynamic:

TESTING AND COMPETITION

Medication effective for low sexual desire in postmenopausal women

TESTOSTERONE

15 y/o male bib parents, does not want to speak with psych

THANK HIM FOR COMING IN AND ASK HIM IF HE'D LIKE TO BE SEEN ALONE OR WITH HIS PARENTS

Child custody determinations in most jurisdictions are made using what principle? (4x)

THE BEST INTEREST OF THE CHILD

5 y/o has been enuretic after mother died in an MVA 4 days ago and keeps saying, "Mommy will come home soon." The father wonders if the children should attend the funeral. What is your recommendation?

THE CHILD AND SIBLING SHOULD BOTH BE ALLOWED TO ATTEND IF THEY WANT TO GO.

Adoptive parents of a child whose birth mother died from suicide are asking about the child's relative risk for future suicidal behavior. Best response? (2x)

THE CHILD'S RISK OF COMPLETED SUICIDE IS ELEVATED RELATIVE TO OTHER ADOPTEES

Scientific development that made NIMH epidemiological catchments area studies possible (9x)

THE DEVELOPMENT OF OPERATIONALIZED DIAGNOSTIC CRITERIA AND STANDARDIZED INSTRUMENTS

43 y/o M successful exec goes to psychiatrist b/c wife threatened to leave if he doesn't change. Doesn't understand wife's complaints that he is perfectionist, demanding, controlling, unavailable. He believes he is just a good man. In forming optimal initial tx plan, considerations for choice of therapy should include: (2x)

THE DIFFICULTY OF DEMONSTRATING TO THE PT THAT HIS EGO SYNTONIC TRAITS ARE MALADAPTIVE

Pts with unipolar depression differ epidemiologically from pts with bipolar d/o in what way?

THE DISCREPANCY BETWEEN MALE FEMALE LIFETIME PREVALENCE RATES IS GREATER.

Psych MD accepts a gift from a pharmaceutical company that makes an antidepressant medication. This is considered ethical under which of the following circumstances?

THE GIFT CONTRIBUTES TO THE PSYCHIATRIST'S EDUCATION OR CARE OF PATIENTS

Which of the following is characteristic of preadolescent children's physical growth?

THE GROWTH RATE FOR BOYS LAGS BEHIND THE GROWTH RATE FOR GIRLS

Kohut's theory of personality is based on?

THE INDIVIDUAL'S NEED FOR EMPATHIC INTERACTION WITH SELFEOBJECTS

Kohut's theory of personality is based on:

THE INDIVIDUAL'S NEED FOR EMPATHIC INTERACTIONS WITH SELFEOBJECTS.

Pt has intractable OCD, with profound morbidity, and considers brain surgery. The surgeon must disclose this in order to obtain a valid informed consent:

THE INFORMATION MOST PATIENTS WOULD WANT TO KNOW. (REALLY?)

Which of the following premises is central to the sociobiologic theory of inclusive fitness?

THE KEY UNIT OF SELECTION IS ACTUALLY GENES RATHER THAN INDIVIDUALS

In treating an older pt with depression who is a successful executive, he offers you some tips on investing. What do you do? Do you accept the offer as a way to validate the patient's success OR explore the pt's meanings and feelings about the offer OR accept the information but do not act on it? (2x)

THE LATTER

80 y/o pt was admitted to a nursing home, an employee of the facility notified the pt about the state's laws on advance directives. During that session, the patient most likely received information about which of the following issues:

THE LIVING WILL

A central premise of object relations theory:

THE MIND IS INHABITED BY MENTAL REPRESENTATIONS OF SELF AND OTHERS

A logarithmic odds (LOD) score for a gene represents what?

THE MOST LIKELY RECOMBINATION FREQUENCY BETWEEN TWO LOCI FROM PEDIGREE DATA

16 y/o says she think she may be pregnant but does not want to involve her parents. What should guide the psychiatrist's actions?

THE PATIENT'S ABILITY TO GIVE CONSENT WILL VARY FROM STATE TO STATE TO STATE

What is characteristic of the placebo effect?

THE PLACEBO EFFECT IS GREATER WHEN THE PT KNOWS THE DOCTOR.

A resident performs a research study utilizing all of the outpatients with any psychiatric disorder, who were treated during the first 2 months of the resident's outpatient experience. The resident discovers that of the 47 patients diagnosed with any psychiatric disorder, six meet the criteria for OCD. Which of the following statistic best defines this info?

THE POINT PREVALENCE OF OCD IS 6/47

This describes the statistical concept of point prevalence:

THE PROPORTION OF A POPULATION WITH A SPECIFIC DISEASE AT ONE SPECIFIC TIME.

Agitated manic pt eval in ED, resisted voluntary psych hospitalization. Psychiatrist said, "You can come in voluntarily & choose when you will be discharged, or I'll involuntarily hospitalize you so you have no say in how long you stay in the hospital". Pt had no SI/HI. Why does psychiatrist's decision not meet standard of care?

THE PSYCHIATRIST'S USE OF COERCION INVALIDATED INFORMED CONSENT

C&L psychiatrist sees a 20 y/o pt with cancer pain on methadone maintenance program. The staff feels that the pt's request for additional narcotics represent drugEseeking behavior. Most appropriate recommendation:

THE PT SHOULD BE GIVEN MORE OPIOID MEDICATION TO ACHIEVE ADEQUATE PAIN CONTROL BECAUSE OF THE PT'S TOLERANCE.

Which of the following is a component of the psychiatrist's formal cultural formulation of a pt's disorder:

THE PT'S EXPLANATION OF THE ILLNESS

Child is shown a rat and does not react. Then show child rat w a loud noise. After several pairing of rat and noise, the child then becomes fearful when just rat presented. In Pavlovian conditioning, what is the conditioned stimulus in this case?

THE RAT

The use of flumazenil for treating benzo OD is limited by ...

THE RISK OF INDUCING WITHDRAWAL SEIZURES IN BENZOE DEPENDENT PTS

In evaluating a patient's competence to consent to a medical treatment, the degree of strictness with which the examining psychiatrist considers the question is most affected by which of the following factors?

THE RISKEBENEFIT RATIO OF THE TREATEMENT

The motivational enhancement therapy model for addiction treatment emphasizes which of the following factors?

THE ROLE OF AMBIVALENCE IN CHANGE

Studies in which monkeys are raised in varying degrees of isolation have been important in contributing to what theories of human development?

THE SIGNIFICANCE OF ATTACHMENT

Which of following statements identifies what both traditional healing and modern psychotherapeutic practices may have in common:

THE THERAPIST HELPS THE PATIENT EXPERIENCE AN EMERGING SENSE OF LEARNING AND MASTERY OVER THE PROBLEM

What best describes current psychoanalytic thinking about the source of countertransference phenomena in the therapist

THE THERAPISTS TOTAL EMOTIONAL REACTION TO THE PATIENT

The personality test in which a pt is shown pictures of situations and asked to describe what is happening in each picture is:

THEMATIC APPERCEPTION TEST (TAT)

Which is a Projective Assessment test:

THEMATIC APPERCEPTION TEST (TAT)

To obtain additional about unconscious drives and psychodynamic processes, which test would be most helpful?

THEMATIC APPRERCEPTION TEST(TAT)

4 y/o child is administered the "false beliefs task" in which two dolls act out a scene, whereby one doll switches the location of a marble from one site to another, while the other doll leaves the scene of the action. When the other doll returns to look for the marble, the child correctly points out that it will look in the original location. This response demonstrates the child is showing evidence of:

THEORY OF MIND

The "false belief" test of young children uses two dolls in an interaction whereby one doll hides a marble in front of a second doll, and then moves marble while second doll leaves the scene. The second doll reEenters scene and child subject is then asked where this doll believes marble to be. This test is used to assess:

THEORY OF MIND

What was most important factor in determining tx outcomes in National Institute of Mental Health Treatment of Depression Collaborative Research Program (1996)?

THERAPEUTIC ALLIANCE

Psychiatrist determines that fully informing a pt of tx risks would negatively impact pt's health/welfare & documents rationale for tx the patient without informing the patient of all the risks. This psychiatrist is intending to use which of the following?

THERAPEUTIC PRIVILEGE

Rogers v. commissioner (1983) is a legal case that addressed the right to refuse antipsychotic meds in nonEemergency situations. Based on this ruling, pts previously adjudicated as incompetent may not refuse meds in which situation?

THERE IS A COURTEAPPROVED SUBSTITUTED JUDGMENT TX PLAN

Which of the following is an effective treatment for mildEtoEmoderately severe idiopathic Raynaud's disease?

THERMAL BIOFEEDBACK

What characterizes the majority of defendants with psychiatric disorders who are found unfit to stand trial?

THEY CAN REGAIN FITNESS IN LESS THAN 90 DAYS

80 y/o pt with bipolar d/o stable on Lithium for years, recently got started on a new med. The pt now has tremulousness, dystonia, hyperreflexia, ataxia, and confusion. Which med might be contributing to pt's presentation

THIAZIDE DIURETIC

Retinal pigmentation from longEterm Tx with:

THIORIDAZINE

What statement describes principles of tx of pt w sexual dysfunction?

THOROUGH MED EVAL AND TREATMENT OF ANY MEDICAL D/O SHOULD BE PERFORMED BEFORE ENTERING THERAPY

Which symptom would indicate MDD rather than just bereavement: Poor appetite and sleep, hearing the voice of the loved one, feelings of guilt or thoughts of suicide?

THOUGHTS OF SUICIDE

Gestational insufficiency of which hormone has been associated with development of severe intellectual disability?

THYROID

BMD Tx with Li x 2 years develops rapid cycling. What lab test should be done?

THYROID FUNCTION TESTS

Pharmacokinetic property most related to relative abuse potential of benzos

TIME TO ONSET OF ACTION

Pt has psychotherapist. Pt referred to psychiatrist who prescribes medication. Psychiatrist's responsibility to pt

TO FOLLOW UP BY SEEING PT AT APPROPRIATE SCHEDULED INTERVALS AND BY COMMUNICATING REGULARLY W/ PSYCHOLOGIST ABOUT PT'S CLINICAL STATUS AND TX PLAN

Individuals carrying inactive alleles of the CYP2A gene have increased coniine levels per unit of drug ingested and are relatively protected from addiction to:

TOBACCO

Pretend play, based on ability to symbolize, typically appears at which of the following stages of development?

TODDLERHOOD

In pts who surreptitiously use excess sulfonylurea, which of the following substances can be administered to r/o possible insulinoma?

TOLBUTAMIDE

This model divides the mind into conscious, preconscious, and unconscious?

TOPOGRAPHICAL

Which of the following models divide the mind into conscious, the preconscious, and the unconscious?

TOPOGRAPHICAL

Factor most predictive of effective methadone Tx

TOTAL DAILY DOSE

What test requires rapid and efficient integration of attention, visual scanning, and cognitive sequencing?

TRAILEMAKING TEST TMT

Tx first line to otherwise healthy 34 y/o man for premature ejaculation?

TRAINING IN BEHAVIORAL TECHNIQUES TO DELAY EJACULATION

32 y/o pt with hx of treatmentEresistant depression presents to ED BIBEfamily after OD on imipramine. Pt swallowed pills, changed her mind and asked for help. Pt's outpt psychiatrist had recently added Imipramine to the pts fluoxetine 80 mg daily. Pt is afebrile, BP 100/58, HR 96 and regular. Pt is vague regarding suicide attempt and states she no longer wants to die. ED wants to admit to psych, psych states the OD attempt was not lethal and not cardiotoxic per pt's report of how many pills she took. What is the best course of action for the psychiatrist to follow?

TRANSFER PT TO A PSYCH UNIT FOR INVOLUNTARY DETENTION

A set of feelings that a patient reenacts in the therapeutic relationship are called:

TRANSFERENCE

Pt reenacts therapeutic relationship

TRANSFERENCE

61y/o pt presents to ED with family who report that the pt unable to remember recent events. Memory problems started 2 hours prior; cognitively intact before episode. Pt is alert, anxious, frustrated: "Why am I in the hospital?" Dx:

TRANSIENT GLOBAL AMNESIA

On the way to airport for vacation, 58 yo F begins to behave in very strange way. Husband notices when he talks to her she answers appropriately w fluent speech but seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her many times. The episode lasts for bout 6 hours. The following day she is back to normal but has no recollection of the prior day events. This episode is most consist with a diagnosis of:

TRANSIENT GLOBAL AMNESIA

2 y/o does not want to let go of wool blanket and resists going anywhere without it. Attachment type is:

TRANSITIONAL OBJECT

Which of the following therapist techniques are more commonly employed in group therapy compared to individual psychotherapies

TRANSPARENCNY AND SELF DISCLOSURE

CrossEdressing for the purpose of sexual excitement is called:

TRANSVESTIC FETISHISM

2 wk waiting period recommended when switching from phenelzine to tranylcypromine because:

TRANYLCYPROMINE IS AN AMPHETAMINE DERIVATIVE

Antidepressant w/ shortest elimination halfElife:

TRAZODONE

Rare occurrences of priapism are most frequently associated with:

TRAZODONE

What pharmacological treatment should be used for longEterm insomnia in pts with dementia over 65 years of age?

TRAZODONE

Constitutional and common law dictate prisoners must receive care at the level or above care they would receive if they were in the community. This "necessaries" doctrine is justified by which of the following principles?

TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE

Constitutional and common law dictate that mental health care provided to prisoners be at or above the level of services that should be available to them if they were in the community. The "necessaries" doctrine is justified by what principle?

TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE.

What are "least restrictive alternatives" for patients with serious mental illnesses?

TREATMENT SHOULD OCCUR IN A SETTING THAT INTERFERES MINIMALLY WITH THE PATIENT'S CIVIL RIGHTS

12 yo arguing w his single parent mother. Mother threatens consequences and child runs to grandmother who then scolds mother for being too harsh. Family dynamic is reflective of?

TRIANGULATION

In family therapy, a previously distant couple begins to communicate more frequently and intimately. After this happened the daughter who used to be close to mom, and has become less so as a consequence of above therapy changes, is more hostile to father. This behavior is called:

TRIANGULATION

Benzo halfElife < 6 hrs

TRIAZOLAM

Increased PR, QRS, or QT on EKG:

TRICYCLICS

Sudden death in children taking which medication?

TRICYCLICS

Lithium serum levels should be monitored by evaluating:

TROUGH LEVELS 12 HOURS AFTER LAST DOSE

Key characteristic of preschoolers who are securely attached

TRUST AND RECIPROCITY

Son of 70 y/o pt calls psych MD to reports his mom has b/c depressed in last 6 months, but pt denies being sad and refuses to see psych MD. Son mentions that he will bring mother to the appointment under the pretense of having her back pain checked. Most appropriate response from psych MD would be to:

TRY TO DISSUADE THE SON FROM USING DECEPTION

32 y/o F, divorced 3 times, sees a male psychiatrist, saying she needs therapy because she is paralyzed about choosing a career. Pt has started and stopped college twice, held several waitress and clerk jobs. She hoped the therapist could tell her what job to pursue. In the initial interview she asks the therapist to send bills directly to her father, who manages her money because she has difficulty managing bills and credit cards. She explained she has to live at home to save money, but hates this because she frequently fights bitterly w her father who always wants to control her. Transference issue that therapist should expect to be central theme in therapy is:

TRY TO GET ADVICE BUT THEN BE ANGRY AT THE THERAPIST FOR GIVING IT

15 y/o pt w/ hx of atypical seizures that include psychomotor attacks and generalized motor episodes. Pt does poorly in school. Exam reveals skin lesion, no other abnormalities. A mutation of which gene?

TSCE1 (TUBEROUS SCLEROSIS GENE 1)

What lab test should be conducted prior to initiation of lithium tx?

TSH

14 y/o girl presents with delayed onset of puberty, short status, and a history of cardiac abnormalities and hypertension. She has poor social skills. Psychological assessment reveals a normal verbal IQ and a belowEnormal performance IQ. Which of the following is the most likely dx?

TURNER SYNDROME

Couple in therapy review argument at family reunion, husband told his sisterEinElaw that his wife was superior to her in every way, the wife expressed disapproval, husband became quiet and later fell down a flight of stairs. What defense mechanism is this?

TURNING AGAINST SELF

A 3 yo child has been expressing angry feelings about the arrival of a new sibling. The child has a secure attachment to parents as well as grandparents who visit frequently. During one such visit, during which the grandparents spend time holding the new baby, the child begins to bang the head rhythmically against a table. According to psychoanalytic theory, this behavior is understood as which of the following?

TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.

For the treatment of pts with compulsive sexual behavior, the best results have been seen with which of the following approaches? (2x)

TWELVE STEP GROUPS

Which study best addresses the relative influences of heritability and environment?

TWIN ADOPTION STUDIES

Two antidepressants are tested alone and as a combo treatment against a waitlist control group in pts with treatment resistant MDD. Both meds are found to have a significant therapeutic effect individually, and the combo treatment is more efficacious than the summed effects of each med given alone. What has been demonstrated? (2x)

TWO TREATMENTS MAIN EFFECTS AND AN INTERACTION EFFECT

Study reports difference that turns out to be by chance

TYPE I ERROR

17 1⁄2 y/o pt mentions drinking "a few beers" at parties and smoking THC "sometimes with friends." The adol is doing well in school. Has close friends and has no significant conflicts at home. Adol's use of substance is best characterized as:

TYPICAL ADOLESCENT BEHAVIOR

A young child tries to determine how many seating arrangements there are for a family of 5 around a table. The child uses no system and spends hours trying to find all options randomly and incompletely. This approach suggests:

TYPICAL APPROACH FOR THIS STAGE OF CONCRETE OPERATIONS

Sex play from 8E13 y/o indicative of:

TYPICAL CHILDREN

85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get?

UA

According to psychoanalytic theory, the term primary process thinking refers to mental activity exemplified by?

UNCONSCIOUS THOUGHTS THAT DO NOT MAINTAIN LOGICAL CONNECTIONS

What characteristic is associated with better adaptation in individuals >65?

UNCRITICAL ACCEPTANCE OF IDEAS

Psych MD is treating a child whose parents are divorced. Under what circumstance is it ethically acceptable for the psychiatrist to have a romantic relationship with the child's parent?

UNDER NO CIRCUMSTANCES

Per Piaget, Conservation is the ability to do what?

UNDERSTAND THAT OBJECTS OR QUANTITIES REMAIN THE SAME DESPITE A CHANGE IN PHYSICAL APPEARANCE

Couples therapy, husband complains that MD wife works too long hours, she says she stays late to make sure everything is "right" checking and rechecking her work. Notes that once in high school she wished her straightcA brother dead and later he died on hunting trip. Her checking behavior is an example of: (2x)

UNDOING

Hand washing rituals are most related to what defense mechanism? (4x)

UNDOING

A famous entertainer comments publicly about having problems cutting down on ETOH use despite knowing negative effects on family members. Wellcknown psychiatrist, never met the entertainer, goes on a news program and says that the entertainer is most likely experiencing ETOH abuse. What explains ethics of MD? (2x)

UNETHICAL BECAUSE THE PSYCHIATRIST HAS NOT EXAMINED THE ENTERTAINER

No harm contract between patients and clinicians are? (2x)

UNHELPFUL IN MAKING DECISIONS

Leading cause of neuropsychiatric disability worldwide

UNIPOLAR MAJOR DEPRESSION

According to Kohlberg, the highest level of moral reasoning is based on consideration of

UNIVERSAL ETHICAL PRINCIPLES

What is the therapeutic factor of treating bulimics in group therapy to openly disclose personal attitudes toward body image and give detailed experiences with binging/purging?

UNIVERSALITY

Infants are more likely to have insecure attachment with poor child care if primary caretakers are also:

UNRESPONSIVE TO THEIR INFANT'S NEEDS

78 y/o w/ deteriorating personal hygiene, significant weight loss. Signs voluntary admission form but later forgets doing this. Potentially resectable masses in lung and brain requiring further consent for surgical and oncological treatment. Consents but cannot explain reason for surgery. Legally, psychiatrist should:

URGENTLY REQUEST PROBATE COURT APPOINT GUARDIAN WITH POWER TO MAKE TREATMENT DECISIONS

27 y/o angry, agitated pt is admitted to the ER. He is evaluated during initial interview as nonEpsychotic and high risk for imminent violence. He refuses medication. What would be the most appropriate intervention at this time?

USE EXTERNAL RESTRAINT WITH CALM REASSURANCE.

Pretend play in preschoolEage depends upon children's increasing ability in which skills

USE OF ONE OBJECT TO REPRESENT ANOTHER

Which of the following is the most powerful predictor of falling in older adults?

USE OF SEDATIVE MEDICATIONS

25 y/o single AfricancAmerican man, who is a first year law student at an ivy league school, seeks psychotherapy for what he calls "academic paralysis." He is falling behind as he spends more time brooding about the racial and socioeconomic differences between himself and his classmates. He feels comfortable with his African American psychiatrist and speaks openly about her racial slights that he experiences every day. The most important goal of dynamic psychotherapy with this pt is to: (2x)

USE THE SHARED ETHNIC BACKGROUND TO OFFER INSIGHT TO EXPLAIN HOW THE PT'S ALIENATION MAY BE ROOTED IN SOMETHING MORE THAN HIS CURRENT SITUATION

In forensic psychiatry, the term "standard of care" refers to the use of treatments that are:

USED BY AVERAGE REASONABLE PRACTITIONERS

Standard of care refers to treatments that are

USED BY AVERAGE REASONABLE PRACTITIONERS

Ability of an infant to utilize symbolic representation at age 18 months allows for:

USING LANGUAGE PROFICIENTLY

All of the following are strategies for change in cognitive therapy:

USING REATTRIBUTION, DEVELOPING ALTERNATIVES, QUESTIONING THE EVIDENCE, FANTASIZING CONSEQUENCES. (NOT EMPLOYING INTERPRETATION)

Which of the following is a principal goal of CBT for panic d/o?

USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS

When using an interpreter during the interview of an immigrant patient, what is most important?

USING YOU INSTEAD OF HE OR SHE

Patient's confidentiality after death

USUALLY MUST BE MAINTAINED

According to classical psychoanalytic theory, what factor primarily accounts for the polarization of same sex peer groups?

UTILIZATION OF DEFENSE MECHANISMS TO AVOID SEXUAL IMPULSES

Which should raise Psych MD's index of suspicion for malingering in cases of litigation in which financial compensation is at issue?

VAGUELY DEFINED SYMPTOMS

What herbal (phytomedicinal) is used as a hypnotic?

VALERIAN

58 yo patient with breast cancer on the C&L service, recently put on palliative level and develops depression. She is hopeless but denies SI. What is the most appropriate response?

VALIDATE THE PATIENT'S FEELINGS

Test measures what it is supposed to measure

VALIDITY

Adequate as a monotherapy for juvenile myoclonic epilepsy:

VALPROATE

Adequate for monotherapy generalized tonic clonic szs:

VALPROATE

Associated with neural tube defect in first trimester of pregnancy:

VALPROATE

Coarsening of facial features and hirsuitism are SE of what med?

VALPROATE

Drug prophylactic for treatment of migraines: (2x)

VALPROATE and TOPIRAMATE

Clinically significant increase in lamotrigine concentration may occur if coc administered with: (5x)

VALPROIC ACID

Interaction between valproic acid and lamotrigine that causes severe derm reactions?

VALPROIC ACID INHIBITS GLUCONURONIDATION

An operant conditioning reinforcement schedule that is used in casino slot machines and may play a role in the development of pathological gambling:

VARIABLEERATIO

What are genetic polymorphisms?

VARIANT DNA SEQUENCES PREVALENT IN >1% OF A POPULATION

Genetic d/o associated with increased risk for schizophrenia:

VELOCARDIOFACIAL

Phenylethylamine antidepressant that targets serotonin and norepinephrine reuptake inhibition

VENLAFAXINE

Which antidepressant med is most likely to cause HTN? (5x)

VENLAFAXINE

Catharsis is: (2x)

VERBAL EXPRESSION OF SUPPRESSED TRAUMATIC EXPERIENCES AND FEELINGS

When interpreting IQ test results, what indicates need for further assessment?

VERBAL SCORE SIGNIFICANTLY HIGHER THAN NONVERBAL SCORE

Pt with PTSD who will have the most favorable prognosis in CBT involving exposure therapy:

VICTIM OF A RANDOM VIOLENT ASSAULT

This tool best measures the degree of selfEcare in children with MR:

VINELAND ADAPTIVE BEHAVIOR SCALE

8 yo chld recently had Wechsler Intelligence Scale for Children (WISCEIV) and received full scale IQ of 60. Which additional tests would determine if child meets criteria for intellectual disability (mental retardation)?

VINELAND ADAPTIVE BEHAVIOR SCALES, 2ND EDITION (VABSEII)

20 y/o pt is brought to ER by friend who is concerned about pt's potential for assaultiveness. Which feature is most indicative of this risk?

VIOLENCE TO OTHERS

Which of the following did Kurt Schneider consider to be a firstErank symptom of schizophrenia?

VOICES ARGUING

Research coordinator requests spouse of patient to participate in study as healthy control. Which feature of informed consent is potentially being violated?

VOLUNTARISM

Pt consumed a large amount of alcohol and discharged a firearm, wounding a neighbor. Pt remember nothing of the incident. What is true about the pt's criminal responsibility per the insanity defense?

VOLUNTARY INTOXICATION DOES NOT EXCUSE THE CRIMINAL BEHAVIOR

Socioeconomic status is correlated to risk for mental illness, such as those who are disadvantaged by social class are more likely to develop a mental d/o. research shows that this correlation is accounted for mainly by greater:

VULNERABILITY TO THE IMPACT OF STRESSFUL LIFE.

Gender is best understood as referring to:

WAYS IN WHICH CULTURES DIFFERENTIATE ROLES BASED ON SEX

What hematological finding necessitates immediate dc of clozaril?

WBC 2000E3000, GRANULOCYTES 1000E1500

"Deficit model" of psychological illness in psychodynamic psychotherapy define psychopathology as:

WEAKENED OR ABSENT PSYCHIC STRUCTURES

"Deficit model" of psychological illness in psychodynamic psychotx defines psychopathology as: (2x)

WEAKENED OR ABSENT PSYCHIC STRUCTURES

In behavioral psychology, extinction is defined as :

WEAKENING OF CONDITIONED RESPONSE DUE TO WITHDRAWAL OF STIMULUS

A psychological test that demonstrates high reliability:

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Measures attention, concentration, and freedom from distractibility:

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Test correlates most strongly w premorbid fcn in pt w early dementia

WECHSLER ADULT INTELLIGENCE SCALE II VOCABULARY TEST

StanfordEBinet most similar to

WECHSLER INTELLIGENCE SCALE FOR CHILDREN - III

Which assessment instrument best measures cognitive functioning in a 4 year old child?

WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCEEREVISED WPPSIER

What is the most common reason pts discontinue valproate?

WEIGHT GAIN

According to structural family therapy, what is the indicator of normal family functioning?

WELL DEFINED BOUNDARY BETWEEN PARENTS AND CHILDREN THAT PERSEVERES AUTHORITY AND FACILITATES OPEN COMMUNICATION

Several states established that the verdict guilty but mentally ill to be an option when a defendant pleads not guilty by reason of insanity because:

WHEN COMPARED TO GUILTY, GUILTY BUT MENTALLY ILL IS INTENDED TO ENSURE ACCESS TO TREATMENT BUT IS ESSENTIALLY SIMILAR

When is a psychiatrist permitted to notify a 3rd party identified to be at risk for contracting HIV from a patient

WHEN PATIENT W AIDS UNWILLING/UNABLE TO TAKE AUTONOMYEPRESERVING PRECAUTIONS LIKE ABSTINENCE

Most appropriate time to discuss advance directives with a pt

WHEN THE PT IS COMPETENT

The most appropriate time for a physician to discuss an advance directive with a pt is

WHEN THE PT IS COMPETENT

When should a schizophrenic admitted to a medical hospital for evaluation of chest pain have a formal assessment of decisionEmaking capacity?

WHEN THERE IS REASON TO BELIEVE THAT THE PATIENT LACKS THE ABILITY TO UNDERSTAND, APPRECIATE, OR REASON LOGICALLY WITH THE INFO RELEVANT TO HEALTHCARE DECISIONS

The most relevant issue for a geriatric or forensic psychiatrist in cases were the finances of an elderly are in dispute between partner and children is:

WHETHER THE ELDERLY HAS A MENTAL DISORDER AND WHETHER IS ADEQUATELY TREATED

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months postEtreatment?

WHOLE BRAIN RADIATION

In documenting suicide riskEassessment, key risk management strategy is to discuss what factors in the record?

WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING

When documenting suicide risk assessment, key strategy is to discuss ...

WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING

What would be a useful screening test to evaluate an 8 y/o child's academic performance?

WIDE RANGE ACHIEVEMENT TEST (WRAT)

Medical resident consults psychiatry because a 38 y/o F pt refused dialysis secondary to "antisocial personality" and the resident wants you to convince her to stay for treatment. Your answer is:

WILL ASSESS PT'S COMPETENCY TO MAKE ONE'S OWN MEDICAL DECISION

Neuropsychological test that specifically evaluates impairments in frontal lobe function in adults?

WISCONSIN CARD SORTING TASK (WCST)

75 y/o pt presents with symptoms of dementia. Especially poor performance on which of the following neuropsychological tests might suggest a Dx of vascular dementia rather than Alzheimer's dementia?

WISCONSIN CARD SORTING TEST (WCST)

Most specific test for assessing executive functioning?

WISCONSIN CARD SORTING TEST (WCST)

On what test would perseverative error be considered a specific outcome of clinical relevance?

WISCONSIN CARD SORTING TEST (WCST)

What test would be considered most useful to specifically evaluate concept formation, reasoning, and executive functioning? (4x)

WISCONSIN CARD SORTING TEST (WCST)

Which of the following tests would be considered most useful to specifically evaluate concept formation with set shifting? (2x)

WISCONSIN CARD SORTING TEST (WCST)

Normal bereavement in prepubertal children

WISH TO UNITE W/ DEAD LOVED ONE

Test more specific to identify specific learning disability in child w/ full scale IQ of 93 on WISCEIII

WOODCOCKEJOHNSON PSYCHOE EDUCATIONAL BATTERY - REVISED

14 y/o Native American girl with visions of elder spirits who appear and give her advice. Parents feel visions are gift but are worried about the child's preoccupations interfering with schoolwork. No h/o mental d/o or substance abuse. Treatment goal:

WORK ON PROBLEMS IN SCHOOL

"Which is important when working w/ family members who are caregivers to pts w/dementia? • There needs only be one caregiver at a time • Grief work w/fam not necessary before pt. dies • All fam to equally share caregiving responsibility • Work w/fam should enhance effectiveness of care to pt. • Fam should explore SNF options as soon as pt is diagnosed "

WORK W/ FAMILY SHOULD ENHANCE EFFECTIVENESS OF CARE TO PT

An important technique in supportive therapy is...

WORKING PRIMARILY IN THE PRESENT

In psychodynamic tx, interpretation of transference & resistance until insight fully integrated is called:

WORKING THROUGH

Menninger's triangle of insight provides a framework for identifying links between the patient's current interpersonal relationships, earlyElife interactions with family members or other important caregivers, and the transferential relationship with the therapist. What is this process?

WORKING THROUGH

In pt with MDD and social phobia the IPT targets social isolation by (2x):

WORKING WITH THE PT TO HELP INCREASE SOCIAL CONTACTS, STRENGTHEN THE CURRENT RELATIONSHIPS.

Which of the following major world events immediately preceded and helped to shape the content of DSMEI?

WORLD WAR II

What is the legal process that asks the court to immediately evaluate if a pt has been hospitalized w/o due process of law? (2x)

WRIT OF HABEAS CORPUS

A resident is discharging a patient and notes a significant omission in the resident's last, handwritten progress note. Which of the following is the best course of action?

WRITE AN ADDENDUM TO THE PROGRESS NOTE WITH THE CURRENT DATE

The reliability of an assessment instrument, such as diagnostic interview, refers to the ability of an instrument to:

YIELD CONSISTENT RESULTS WHEN USED BY DIFFERENT EXAMINERS OR AT DIFFERENT TIMES.

A finding regarding epidemiology of nicotine use:

YOUNG ADULTS REPORT THE HIGHEST RATES OF SMOKING

What is used to report the deviation of a value from its group mean, expressed in standard deviation units? (2x)

Z SCORE

42 y/o pt has primary insomnia. Pt complains of difficulty falling asleep, but then sleeps through the night. Which of the following would be the best medication to prescribe for this pt after addressing sleep issues:

ZALEPLON

Which atypical antipsychotic causes least weight gain?

ZIPRASIDONE

FirstEline med for insomnia in 78 y/o pt with dementia:

ZOLPIDEM

Antipsychotic drug adrenergic effect causing orthostatic hypotension

Α1EBLOCKADE